SynthesisJournal of orthopaedic surgery and research2025
Management of idiopathic clubfoot: an umbrella review and CPAM-LRC consensus: Limb Reconstruction Committee of Orthopedics Branch of China International Exchange and Promotion Association for Medical and Health Care (CPAM-LRC).
Synthesis in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo develop evidence-based consensus guidelines for idiopathic clubfoot treatment in children by integrating a comprehensive evidence synthesis with expert consensus.
methodsWe performed a PRISMA-compliant umbrella review of published systematic reviews, meta-analyses, and clinical guidelines on idiopathic clubfoot management. Inclusion criteria covered any intervention and outcomes for idiopathic clubfoot. Two reviewers independently screened studies and assessed quality using the Joanna Briggs Institute checklist. Data were extracted and qualitatively synthesized due to heterogeneity, grouping evidence by clubfoot type, treatment modality, and outcome domain. A 25-member expert panel then formulated consensus recommendations via a modified Delphi process (two survey rounds and a final consensus meeting) with a 75% agreement threshold.
resultsA total of 47 publications met inclusion (41 systematic reviews and 6 guidelines). Most included reviews were of moderate quality on JBI assessment. The evidence confirmed the Ponseti serial casting method as the gold-standard for idiopathic clubfoot. Ponseti casting achieved pooled initial correction rates of 96-98%, with relapse in 20-30%. It significantly outperformed older methods: relapse risk was roughly halved versus Kite's casting, and Ponseti yielded better long-term outcomes than extensive surgery (73% vs. 62% good/excellent results) while drastically reducing the need for major surgical release. In non-idiopathic (syndromic/neurogenic) clubfoot, Ponseti still attained 91% initial correction but only 68% long-term success due to higher relapse (30-40%). The Delphi panel reached consensus on 14 statements reflecting these findings. Key recommendations include initiating Ponseti treatment within the first 2-6 weeks of life, using Achilles tenotomy and bracing to maintain correction, reserving extensive surgery for only refractory cases, managing relapses with repeat casting and limited surgery, ensuring long-term follow-up, and promoting standardized Ponseti training.
conclusionCombining a rigorous umbrella review with Delphi consensus yielded robust, evidence-informed guidelines. The CPAM-LRC consensus confirms Ponseti as first-line treatment and provides an expert-endorsed framework for adjunct interventions and follow-up, which should improve the consistency and outcomes of idiopathic clubfoot care.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.