Efficacy of ankle-foot orthosis as an adjunct to foot abduction brace for clubfoot relapse prevention in Ponseti

Abstract

Background: Clubfoot is a common congenital musculoskeletal deformity which potentially leads to disability with rising incidence in Zambia. Despite effectiveness of Ponseti methods, relapse rates remain high in resource-limited settings including Zambia.
Aim: The study evaluated the effectiveness of combining ankle-foot orthosis (AFO) with Foot Abduction Brace (FAB) versus standard FAB alone in preventing relapses after Ponseti management.
Setting: University Teaching Hospital, Lusaka, Zambia.
Methods: Thirty-four patients with clubfoot were randomised to Group A (AFO+FAB, n = 17) or Group B (FAB alone, n = 17). AFO was worn during the day while the FAB was worn at sleep times either day or night. Group B only wore the FAB during sleep time. Both groups wore the devices every day for six consecutive months. Outcomes included range of motion, functional activity and relapse rates.
Results: The mean age in months was 25.41 (8.57) for the FAB group and 24.00 (7.79) for the AFO+FAB group. The AFO+FAB group experienced less decline in dorsiflexion range of motion (ROM) than the control group (β = 2.96, p = 0.007). The AFO+FAB group had a higher Ponseti functional score (β = 19.01, p < 0.001), and a lower Pirani score at the end of the study compared to FAB group (β = –0.51, p = 0.018).
Conclusion: AFO+FAB improves functional outcomes and shows promising results in managing clubfoot severity.
Contribution: This study identified that children with clubfoot may benefit from combining the two devices as it may help prevent ROM loss and improve functional activity.