Psychological impact of idiopathic clubfoot on Mothers: Insights from the ICCAP questionnaire.

Background: Mothers who have a newborn with a physical defect often experience significant psychological distress. We surveyed mothers of children born with clubfoot to understand what parameters of parents' quality of life and health are primarily affected and the changes thereof at correction of the deformity to guide the counseling process. Methods: The affected mothers were administered the Impact of a Child with Congenital Anomalies on Parents (ICCAP) questionnaire. The responses were recorded prospectively at the enrolment of the child for treatment (foot with obvious clubfoot deformity) and one month post Achilles tenotomy (foot deformity fully corrected). Statistical analysis involved the use of mean responses for each ICCAP domain and intertreatment comparisons. Results: Results were analyzed for 29 mothers. The affected mothers were largely satisfied (91.4 %) with their first contact with caregivers. The confidence grew significantly following the correction of deformity (scores improving from 4.39 ± 0.59 to 4.74 ± 0.3; p = 0.005). The social support remained strong throughout the Ponseti treatment. The partner relationships (pretreatment 4.57 ± 0.75; post treatment scores 4.48 ± 0.82; p = 0.69) and child acceptance (pretreatment 4.18 ± 0.62; post treatment 4.04 ± 0.59; p = 0.38) were also overall strong although somewhat affected by the casts and bracing protocol. The affected mothers recovered from a sad and depressed state following visualization of corrected deformity (pretreatment scores 3.09 ± 0.92 improving to 2.92 ± 1.04 post treatment; p = 0.52). They however continued to experience fear and anxiety regarding their child's immediate and long-term future (pretreatment scores of 3.42 ± 0.65 deteriorating to 3.56 ± 0.55 at the initiation of bracing; p = 0.34). Conclusions: Mothers of children with clubfoot generally adapted well despite the child's physical deformity. The mother was subjected to early psychological stress which can extend even post correction of deformity. We suggest dedicated counseling of the affected clubfoot parents by the subject experts. The same may require periodic reinforcements during the treatment.