Early and late initiation of the Ponseti method yield comparable outcomes in congenital idiopathic clubfoot: a systematic review and meta-analysis

Introduction: The optimal timing to initiate the Ponseti method for congenital idiopathic clubfoot remains uncertain. This systematic review and meta-analysis aimed to evaluate whether starting treatment within the first four weeks of life improves outcomes compared to later initiation. Methods: Following PRISMA guidelines (PROSPERO ID: CRD42025650117), MEDLINE, Embase, Cochrane Library, and Google Scholar were searched for studies comparing early (≤4 weeks) versus late (>4 weeks) initiation of the Ponseti method. Outcomes included the number of casts, the relapse rate, and the need for tenotomy. Data were pooled using a random-effects model, and study quality was assessed using the MINORS tool. Results: Six studies involving 467 patients (689 feet) met the inclusion criteria. Early initiation was associated with a slightly higher mean number of casts (MD = 0.72, 95% CI [0.33–1.10], p = 0.0002), but this difference was not significant in the overall pooled analysis (MD = 0.06, 95% CI [−1.08–1.21], p = 0.91). Relapse (OR = 0.70, p = 0.68) and tenotomy rates (OR = 0.68, p = 0.41) were comparable between groups. Discussion: Although earlier treatment may require more casts, it does not reduce relapse or tenotomy rates. These findings suggest that initiating treatment after four weeks yields comparable outcomes, offering flexibility in clinical practice without compromising results. Variability across studies highlights the need for standardized treatment protocols and well-designed randomized controlled trials to confirm the optimal initiation age.