Evidence map›Paper›PMID 42210173›Full record

Observational studyBMC musculoskeletal disorders2026

Contemporary national treatment patterns for clubfoot relapse-related interventions: a large multi-institutional cohort.

Christopher D Hamad, Joshua Wiener, Timothy Liu, Autreen Golzar, Al-Hassan J Dajani, David C Kaelber, Nicholas M Bernthal, William L Sheppard, Soroush Baghdadi, Mauricio Silva

Abstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC musculoskeletal disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Christopher D HamadDepartment of Orthopaedic Surgery, University of California, 1225 15th Street - Suite 3144B Santa Monica, Los Angeles, CA, 90404, USA.
Joshua WienerDepartment of Orthopaedic Surgery, University of California, 1225 15th Street - Suite 3144B Santa Monica, Los Angeles, CA, 90404, USA.
Timothy LiuDepartment of Orthopaedic Surgery, University of California, 1225 15th Street - Suite 3144B Santa Monica, Los Angeles, CA, 90404, USA.
Autreen GolzarDavid Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Al-Hassan J DajaniDavid Geffen School of Medicine, University of California, Los Angeles, CA, USA.
David C KaelberPopulation and Quantitative Health Sciences, Case Western Reserve University and the Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA.
Nicholas M BernthalDepartment of Orthopaedic Surgery, University of California, 1225 15th Street - Suite 3144B Santa Monica, Los Angeles, CA, 90404, USA.
William L SheppardDepartment of Orthopaedic Surgery, University of California, 1225 15th Street - Suite 3144B Santa Monica, Los Angeles, CA, 90404, USA.
Soroush BaghdadiDepartment of Orthopaedic Surgery, University of California, 1225 15th Street - Suite 3144B Santa Monica, Los Angeles, CA, 90404, USA. SBaghdadi@mednet.ucla.edu.
Mauricio SilvaDepartment of Orthopaedic Surgery, University of California, 1225 15th Street - Suite 3144B Santa Monica, Los Angeles, CA, 90404, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWhile the Ponseti method is the gold standard for treatment of congenital clubfoot, recurrence after initial correction remains common. Most published data describing management of recurrent deformity are derived from single center series, and national practice patterns are not well defined. The purpose of this study was to characterize contemporary utilization of interventions used as proxies for clubfoot recurrence in a large multi-institutional database. MATERIALS AND

methodsWe conducted a retrospective descriptive study using the TriNetX Research Network. Children diagnosed with idiopathic clubfoot at one year of age or younger were identified and followed longitudinally for up to seven years after an index ambulatory visit. Relapse related interventions were defined using CPT codes and included repeat casting, repeat Achilles tenotomy, tibialis anterior tendon transfer, and bony osteotomies. Kaplan Meier analyses were used to estimate the cumulative probability of remaining free from each intervention over time.

resultsThe final cohort included 4,522 children with early diagnosed idiopathic clubfoot and longitudinal follow up. Any relapse-related intervention occurred in 23.11% of children, with repeat casting being the most common (16.08%). Tibialis anterior tendon transfer was performed in 6.23% and repeat Achilles tenotomy in 5.75% of eligible patients. Bony procedures were uncommon, with calcaneal osteotomy performed in 0.75%, tarsal osteotomy in 1.64%, and first metatarsal osteotomy in 0.27% of children. Kaplan Meier estimates demonstrated that casting and tendon procedures occurred earlier in childhood, whereas osteotomies were rare late interventions with procedural free survival exceeding 97% at seven years.

conclusionsIn this large national cohort of children with idiopathic clubfoot, procedure-based interventions consistent with recurrence occurred in approximately one-quarter of patients, with repeat casting representing the predominant management strategy. Tendon procedures were used selectively, and bony procedures were rare, reinforcing their role as salvage interventions for rigid or multiply recurrent deformities. These population level data provide contemporary benchmarks for counseling families, guiding expectations, and informing future research on recurrence management following Ponseti treatment.

Indexed as

ClubfootAchilles TendonCasts, SurgicalFemaleFollow-Up StudiesHumansInfantLongitudinal StudiesMaleOsteotomyRecurrenceRetrospective StudiesTendon TransferTenotomyTreatment OutcomeClubfootEpidemiologyPediatric orthopaedicsPonseti methodRecurrenceSerial castingTibialis anterior tendon transfer

Identifiers

PMID42210173
PMCPMC13422288

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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.