Brace non-adherence and relapse after Ponseti treatment for idiopathic clubfoot: a focused updated scoping review.

Abstract

Brace non-adherence remains a vulnerable component of Ponseti treatment for idiopathic clubfoot and is closely linked to relapse after correction. This focused, updated scoping review aimed to synthesize recent relapse-relevant evidence and clarify its added value beyond the 2024 scoping review by Paterson et al. Paterson et al. was used as the pre-update anchor through 16 June 16, 2022. A focused update from 17 June 2022 to 1 May 2026 used PubMed/MEDLINE, Europe PMC, PEDro, Cochrane Library checks, ClinicalTrials.gov, citation searching, and accessible grey-literature sources. Searches combined controlled vocabulary and free-text terms for clubfoot/clubfeet, Ponseti treatment, brace terminology, adherence, relapse, cost/access, and care organization. The anchor review included 42 studies. The focused update retained 19 empirical studies and six contextual or grey-literature items. Evidence supported six domains: adherence-relapse association, brace type and tolerance, cost/transport/access, insurance or public-service variables, specialized clubfoot teams, and contextual differences between high-income and lower-resource settings. Missed visits, brace interruption, transportation burden, caregiver understanding, and continuity of care were repeatedly associated with relapse-related outcomes. Brace non-adherence should be approached as a modifiable pathway shaped by families, brace tolerance, access burden, and care organization.