Treatment outcome of the Ponseti method for clubfoot in Africa : a systematic review and meta-analysis.

Abstract

Clubfoot (congenital talipes equinovarus) is a significant cause of childhood disability globally, with the highest burden in low- and middle-income countries, particularly in Africa. The Ponseti method has emerged as the gold standard for treating clubfoot; however, evidence on its treatment outcomes across African nations remains scattered. We conducted a systematic review and meta-analysis to evaluate the overall and regional outcomes of the Ponseti method in Africa, focusing on success rate, relapse, treatment failure, brace non-compliance, and loss to follow-up. A comprehensive search was conducted in PubMed, Scopus, Hinari, Lens.org, and Google Scholar from inception to 31 May 2025. Additional studies were identified through citation tracking using Citation Chaser. Studies reporting clinical outcomes of the Ponseti method in African populations were included. Quality assessment was conducted using the Joanna Briggs Institute (JBI) checklist. A random-effects model was used to calculate pooled estimates. Subgroup and sensitivity analyses were also performed, and heterogeneity was assessed using I² statistics and p-values. A total of 47 institution-based studies from 15 African countries involving 7,214 participants and 8,135 feet met the inclusion criteria. The overall success rate was 84.8% (95% CI 78.7 to 91.0) by participants and 83.5% (95% CI 78.9 to 88.2) by feet. Relapse was reported in 11.7% (95% CI 7.8 to 15.7) of participants and 12.6% (95% CI 9.3 to 15.9) of feet. Tenotomy was performed in 65.6% of participants and 59.5% of feet. Treatment failure affected 5.1% of feet. Loss to follow-up was 17.4%, and brace non-compliance occurred in 9.2% of patients. Subgroup analysis showed the highest success rate in West Africa (90%) and the lowest in East Africa (73%). Heterogeneity was substantial (I² > 85%). The Ponseti method shows high effectiveness in African settings. However, relapse and follow-up issues remain key challenges. Hence, region-specific strategies are needed to improve long-term outcomes.