Effectiveness of the ponseti method in treating neurogenic clubfoot: a systematic review and meta-analysis.

Abstract

The outcomes of the Ponseti method in neurogenic clubfoot remain uncertain due to deformity rigidity and high relapse risk. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of Ponseti treatment in pediatric neurogenic clubfoot. Following PRISMA 2020 guidelines, we searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus through May 2025. Eligible studies reported Ponseti outcomes in pediatric neurogenic clubfoot. Two reviewers independently assessed study quality using the Newcastle-Ottawa Scale. Random-effects meta-analyses were performed using R software (version 4.5.1) with the meta package in RStudio. Heterogeneity was assessed using I² statistics, and publication bias was evaluated using funnel plots and Egger test. Thirteen studies comprising 214 patients with 336 feet and mean follow-up of 3.6 years [range 2.0-12.0] were analyzed. Initial correction was achieved in 90% of cases (95% CI 86-93%), while long-term success declined to 77% (95% CI 53-90%). Recurrence occurred in 52% (95% CI 37-66%), and complications in 28% (95% CI 13-50%). Mean cast number was 5.88, with Achilles tenotomy required in 87% (95%CI 70-95%). Subgroup analysis revealed excellent homogeneity in myelomeningocele patients (I² = 0%) with 87% success rate. The Ponseti method demonstrates significant efficacy in neurogenic clubfoot management, achieving initial correction in approximately 90% of cases. However, the elevated recurrence rate of 52% necessitates structured long-term surveillance and timely interventions to maintain correction. Given inherent sensory impairments in this population, vigilant monitoring for cutaneous complications is essential. These findings support the Ponseti method as the preferred initial treatment approach for neurogenic clubfoot. PROSPERO CRD420251060145.