PSYCHOLOGICAL EFFECTS OF PONSETI METHOD ON THE PARENTS OF PATIENTS WITH CLUB FOOT DEFORMITY

Authors

  • Muhammad Adnan Khan Khan Khyber Teaching Hospital (KTH), Peshawar, Pakistan. Author
  • Sikandar Hayat Khyber Teaching Hospital (KTH), Peshawar, Pakistan. Author
  • Syed Maaz Ali Shah Khyber Teaching Hospital (KTH), Peshawar, Pakistan. Author
  • Azeem khan Khyber Teaching Hospital (KTH), Peshawar, Pakistan. Author
  • Wali Rahman Khyber Teaching Hospital (KTH), Peshawar, Pakistan. Author
  • Shujaat Adnan Khyber Teaching Hospital (KTH), Peshawar, Pakistan. Author

DOI:

https://doi.org/10.71000/e1g5r048

Keywords:

Anxiety, Clubfoot, , Depression, Orthopedic Procedures, Parents, Pediatric Orthopedics, Psychological Stress

Abstract

Background: Congenital clubfoot is among the most common musculoskeletal deformities in newborns, typically managed through the Ponseti method—a highly effective, non-surgical technique. However, the prolonged and demanding nature of this treatment places significant psychological stress on parents, which may affect both caregiver well-being and treatment adherence.

Objective: To determine the frequency of anxiety and depression among parents of children with congenital clubfoot undergoing Ponseti method treatment.

Methods: This cross-sectional study was conducted over six months in the Department of Orthopedics at Khyber Teaching Hospital, Peshawar. A total of 144 parents of children receiving Ponseti treatment were recruited through non-probability consecutive sampling. The Hospital Anxiety and Depression Scale (HADS) was used to assess psychological status. Demographic and clinical variables were recorded, and data were analyzed using IBM SPSS version 25. Frequencies, percentages, means, and standard deviations were calculated. Chi-square and Fisher’s exact tests were applied with a significance level set at p ≤ 0.05.

Results: Among the 144 participants, anxiety was reported in 77 (53.5%) and depression in 63 (43.8%) caregivers. HADS scores revealed that 26.4% of parents had abnormal anxiety levels and 20.1% had abnormal depression scores. Mothers reported higher psychological burden than fathers. Factors such as urban residence, lower education level, and prolonged bracing were associated with increased psychological distress.

Conclusion: A substantial proportion of parents experience clinically significant anxiety and depression during the Ponseti treatment process. Incorporating psychological support and counseling into standard care protocols is essential to enhance caregiver resilience, treatment adherence, and overall outcomes.

Author Biographies

  • Muhammad Adnan Khan Khan, Khyber Teaching Hospital (KTH), Peshawar, Pakistan.

    PGR FCPS Orthopaedic, Department of Orthopaedic, Khyber Teaching Hospital (KTH), Peshawar, Pakistan.

  • Sikandar Hayat, Khyber Teaching Hospital (KTH), Peshawar, Pakistan.

    Professor Orthopaedic, Department of Orthopaedic, Khyber Teaching Hospital (KTH), Peshawar, Pakistan.

  • Syed Maaz Ali Shah, Khyber Teaching Hospital (KTH), Peshawar, Pakistan.

    PGR FCPS Orthopaedic, Department of Orthopaedic, Khyber Teaching Hospital (KTH), Peshawar, Pakistan.

  • Azeem khan , Khyber Teaching Hospital (KTH), Peshawar, Pakistan.

    PGR FCPS Orthopaedic, Department of Orthopaedic, Khyber Teaching Hospital (KTH), Peshawar, Pakistan.

  • Wali Rahman, Khyber Teaching Hospital (KTH), Peshawar, Pakistan.

    PGR FCPS Orthopaedic, Department of Orthopaedic, Khyber Teaching Hospital (KTH), Peshawar, Pakistan.

  • Shujaat Adnan , Khyber Teaching Hospital (KTH), Peshawar, Pakistan.

    PGR FCPS Orthopaedic, Department of Orthopaedic, Khyber Teaching Hospital (KTH), Peshawar, Pakistan.

References

Rangasamy K, Baburaj V, Gopinathan NR, Sudesh P. Techniques, anaesthesia preferences, and outcomes of Achilles tenotomy during Ponseti method of idiopathic clubfoot correction: A systematic review. Foot (Edinb). 2022; 52:101922.

Chergui S, Al-Ali H, Marwan Y, Abu Dalu K, Dahan-Oliel N, Hamdy RC. Talectomy for arthrogrypotic foot deformities: A systematic review. Foot Ankle Surg. 2023;29(1):15-21.

Quinlan R, Pacey V, Ilhan E, Gibbons P, Gray K. Subgroups of Idiopathic Clubfoot Can Predict Short-term Outcomes. J Pediatr Orthop. 2023;43(5):326-31.

Sheik-Ali S, Navarro SM, Keil E, Lavy C. The role of clubfoot training programmes in low- and middle-income countries: a systematic review. Trop Doct. 2020;50(4):291-9.

Chen SN, Ragsdale TD, Rhodes LN, Locke LL, Moisan A, Kelly DM. Prospective, Randomized Ponseti Treatment for Clubfoot: Orthopaedic Surgeons Versus Physical Therapists. J Pediatr Orthop. 2023;43(2):e93-e9.

Noonan SO, Hetzel S, Noonan KJ, Herzenberg JE, Bae DS, Shore BJ. Ponseti Clubfoot Casting: Factors That Affect Trainee Competency (Retrospective Observational Study). J Am Acad Orthop Surg Glob Res Rev. 2022;6(2).

Barkham B, McNally T, Russell A, Bridgens A, Gelfer Y. Percutaneous Achilles tenotomy under local anaesthetic in the clubfoot clinic was safe during the COVID-19 pandemic, for both children and parents. Int Orthop. 2021;45(9):2271-6.

Allart E, Sturbois-Nachef N, Salga M, Rosselin C, Gatin L, Genêt F. Neuro-Orthopedic Surgery for Equinovarus Foot Deformity in Adults: A Narrative Review. J Foot Ankle Surg. 2022;61(3):648-56.

Trout SM, Whitaker AT. Management issues of congenital talipes equinovarus in the neonatal intensive care unit: A systematic review. Foot Ankle Surg. 2021;27(5):480-5.

Rastogi A, Agarwal A. Long-term outcomes of the Ponseti method for treatment of clubfoot: a systematic review. Int Orthop. 2021;45(10):2599-608.

Brierty A, Horan S, Giacomozzi C, Johnson L, Bade D, Carty CP. Kinematic differences in the presentation of recurrent congenital talipes equinovarus (clubfoot). Gait Posture. 2022;96:195-202.

Al-Mohrej OA, Alshaalan FN, Alhussainan TS. Is the modified Ponseti method effective in treating atypical and complex clubfoot? A systematic review. Int Orthop. 2021;45(10):2589-97.

Novintan S, Campioni-Norman D, Hulme A. Investigations and management of complex congenital talipes equinovarus. BMJ Case Rep. 2024;17(2).

Pinto D, Agrawal A, Agrawal A, Sinha S, Aroojis A. Factors Causing Dropout From Treatment During the Ponseti Method of Clubfoot Management: The Caregivers' Perspective. J Foot Ankle Surg. 2022;61(4):730-4.

Silvani S. The Evolution of the Treatment of Clubfoot from Posterior Medial Release to the Ponseti Technique: My 42-Year Journey at the Permanente Medical Group. Clin Podiatr Med Surg. 2024;41(1):1-16.

Agarwal A, Mittal P, Garg V, Patel Y, Sachdeva K, Ks A, et al. Evaluating the quality of life in mothers caring for children with congenital clubfoot: prospective sequential evaluation along the course of Ponseti management. J Pediatr Orthop B. 2025;34(2):185-8.

López-Carrero E, Castillo-López JM, Medina-Alcantara M, Domínguez-Maldonado G, Garcia-Paya I, Jiménez-Cebrián AM. Effectiveness of the Ponseti Method in the Treatment of Clubfoot: A Systematic Review. Int J Environ Res Public Health. 2023;20(4).

Cady R, Hennessey TA, Schwend RM. Diagnosis and Treatment of Idiopathic Congenital Clubfoot. Pediatrics. 2022;149(2).

Hussain B, Rehman S, Jan A, Hussain G, Khan MA. Comparison Of Accelerated Vs Standard Ponseti Technique Among Children's Having Congenital Talipes Equinovarus. J Ayub Med Coll Abbottabad. 2022;34(Suppl 1)(3):S622-s6.

Williams ML, Dobbs MB. Clubfoot: Emphasis on the Complex and Atypical Subsets. Clin Podiatr Med Surg. 2024;41(1):17-25.

Hopwood S, Khan F, Kemp J, Rehm A, Ashby E. Clubfoot: an overview and the latest UK guidelines. Br J Hosp Med (Lond). 2023;84(1):1-7.

Hussain F, Ali P, Bhatti A, Mahmood K, Somro S, Zafar K et al. Frequency of Psychosocial Impact on Parents of Children Undergoing Ponseti Treatment for Clubfeet, with Special Reference to Compliance to Foot Abduction Bracing. EC Orthop. 2020; 11(8): 90-6.

Pietrucin-Materek M, van Teijlingen ER, Barker S, Keenan KF, Miedzybrodzka Z. Parenting a child with clubfoot: A qualitative study. Int J Orthop Trauma Nurs. 2021;15:176-84.

Coppola G , Costantini A, Tedone R, Pasquale S, Elia L, Barbaro MF, et al. The impact of the baby's congenital malformation on the mother's psychological well-being: an empirical contribution on the clubfoot. J Paediatr Orthop. 2022;32(5):521-6.

Downloads

Published

2025-07-19

How to Cite

1.
Khan MAK, Sikandar Hayat, Syed Maaz Ali Shah, Azeem khan, Wali Rahman, Shujaat Adnan. PSYCHOLOGICAL EFFECTS OF PONSETI METHOD ON THE PARENTS OF PATIENTS WITH CLUB FOOT DEFORMITY. IJHR [Internet]. 2025 Jul. 19 [cited 2025 Sep. 25];3(4 (Health and Rehabilitation):780-6. Available from: https://insightsjhr.com/index.php/home/article/view/1301