Background
Methods
Search strategy
1 | clubf??t or club-f??t or (club ADJ1 foot) or (talipes ADJ1 equinovarus) or (talipes ADJ1 equino-varus) or (congenital ADJ1 talipes ADJ1 equinovarus) or (congenital ADJ1 talipes ADJ1 equino-varus) or CTEV |
2 | Ponseti |
3 | Country name in sub-Saharan Africaa
|
4 | 1 AND 2 AND 3 |
Data extraction
Assessment of study quality
Data analysis
Results
Search results
Study characteristics
Primary Author Year Country | Number of children and (feet) treated | Age Range | Type of study (Level of Evidence) | Comparator Group | Duration of Follow up |
---|---|---|---|---|---|
Ibraheem 2017 [21], Nigeria | 23 (14) | <3 months | Randomised controlled trial (II) | Children managed by accelerated Ponseti treatment | 32–77 days. |
Malagelada 2016 [32], South Africa | 65 (91) | 4–63 months | Cross sectional survey (IV) | Cases in a UK urban clinic | Not applicable |
Smythe 2016 [35], Zimbabwe | 173 (268) | 17 days – 5 years 7 months | Case series, retrospective (IV) | Pre-treatment status of cases | 10.2 weeks (9.5–10.9) |
Boakye 2016 [38], Ghana | 271 (430) | <6 months | Case series, Retrospective (IV) | Pre-treatment status of cases | Not reported |
Adegbehingbe 2015 [39], Nigeria | 4931 (7745) | Not reported | Case series (IV) | Pre-treatment status of cases | Not reported |
Adewole 2014 [33], Nigeria | 106 (158) | 7 days – 4 years | Case series, prospective (IV) | Pre-treatment status of cases | Mean: 3 years (range 2–4) |
Ayana 2014 [24], Ethiopia | 22 (32) | 2–10 years | Case series, prospective (IV) | Pre-treatment status of cases | Not reported |
Kouamo 2014 [40], Togo | 24 (41) | 17 days - 7 years | Case series, prospective (IV) | Pre-treatment status of cases | Not applicable |
Mang’oli 2014, Kenya | 223 (361) | Mean 23 months | Cross sectional survey (IV) | Status of cases at previous appointment | One year |
Kaseke 2013 [41], Zimbabwe | 14 (20) | Mean 7.43 weeks | Non randomised, prospective (III) | Children managed with Kite technique | 6 weeks |
Adegbehingbe 2012 [42], Nigeria | 493 (749) | Not reported | Case series, prospective (V) | Pre-treatment status of cases | Not reported |
Cashman 2012 [20], Malawi | >2000 | Not reported | Case series (IV) | No comparator | Not reported |
Pirani 2012 [43], Uganda | 370 | Majority under 14 weeks | Case series, prospective (IV) | Pre-treatment status of cases | Not reported |
Harnett 2011 [44], Malawi | 21 (32) | <2 months | Randomised controlled trial (II) | Children managed by accelerated Ponseti treatment | Mean 258 days (70 to 348) |
Adegbehingbe 2010 [25], Nigeria | 55 (80) | <18 years | Randomised controlled trial (II) | Children treated by surgery | 3–36 months post last cast |
Radler 2010 [45], Mali | 52 | < 1 year | Case series (IV) | Pre-treatment status of cases | Not reported |
Firth 2009 [30], South Africa | 70 (106) | 1 day – 40 months | Case series, retrospective (IV) | Pre-treatment status of cases | Mean: 2 years 5 months |
Biruk 2007 [26], Ethiopia | 55 (82) | < 6 months | Case series, prospective (IV) | Children in different age category | Not reported |
Lavy 2007 [28], Malawi | 307 (482) | <12 months | Case series, retrospective (IV) | Pre-treatment status of cases | Not reported |
Khan 2005 [27], South Africa | (61) | Not reported | Case series (IV) | Pre-treatment status of cases | Not reported |
Tindall 2005 [29], Malawi | 75 (100) | Under 4 years | Case series, prospective (IV) | Pre-treatment status of cases | 5 ft followed for 12-18 months |
Mkandawire 2003 [36], Malawi | 54 | Under 2 years | Case series, Prospective (IV) | Pre-treatment status of cases | 12 months |
Definition of success – Primary outcome
Primary Author Year Country* | Clubfoot severity assessment | Reported Success Measure | Recurrence / relapse | Additional surgical intervention |
---|---|---|---|---|
Ibraheem 2017 [21], Nigeria | Pirani score | Number of days in casts, number of casts applied | Not reported | Not reported |
Malagelada 2016 [32], South Africa | Pirani score | Parent reported outcomes | 12% (8 children) | Not reported |
Smythe 2016 [35], Zimbabwe | Pirani Score | 85% feet; Pirani score < 1 | Not reported | Not reported |
Boakye 2016 [38], Ghana | Pirani Score | Number of casts to correction. Correction not defined. | Not reported | Not reported |
Adegbehingbe 2015 [39], Nigeria | Not reported | 89.7% (4426 patients) satisfactory outcome. Criteria for satisfactory outcome not defined. | 4% (253 feet, 194 patients) | 3% |
Adewole 2014 [33], Nigeria | Pirani score and photograph | 100%; based on clinical judgement, Plantigrade functional foot | 5.16% (8 feet) | 6 feet |
Ayana 2014 [24], Ethiopia | Pirani score | 28/41 good results Good = correction of all deformities. 97.8% achieved score of <3 | 2 patients, 4 feet | 8 children/ (11 feet) |
Kouamo 2014 [40], Togo | Not reported | 94% (179/190) compliant with brace wear 93.5% no visible discomfort | 12.2% (5 cases) | Not reported |
Mang’oli 2014 , Kenya | Pirani score | Initial correction: 96.2% (152 feet) Initial correction not defined. | Not reported | Not reported |
Kaseke 2013 [41], Zimbabwe | Pirani score | Rate of correction: Pirani score at 3 weeks and 6 weeks | Not reported | Not reported |
Adegbehingbe 2012 [42], Nigeria | Pirani Score | 89.7% treated successfully. Criteria for success not defined. | Not reported | 3.2% (16 patients) |
Cashman 2012 [20], Malawi | Not reported | 30 children failed treatment (required more extensive surgery) | Not reported | 30 children |
Pirani 2012 [43], Uganda | Pirani Score | Mean score 5.4 falls to <2 by cast 6. Primary outcome not defined. | Not reported | Not reported |
Harnett 2011 [44], Malawi | Pirani Score | Pirani score change. Median start Pirani: 5 (4 to 6). Median at tenotomy /end treatment: 0.5 (0.5 to 1) Median at 6 months: 0.5 (0 to 0.5) | No episodes of recurrence after 6 months | 3 patients not corrected (7%) with Pirani >1 |
Adegbehingbe 2010 [25], Nigeria | Dimeglio classification | 96.4% (53/55 children) = satisfactory (No recurrence) 3.6% (2/55) = fair (recurrence corrected with casts/FAB) Nil = poor (recurrence with repeat surgery) | 2 had recurrence between 4 and 6 months | None |
Radler 2010 [45], Mali | Not reported | 77% (40 children): good or average. 23% (12 children): poor. Primary outcome not defined. | Not reported | Not reported |
Firth 2009 [30], South Africa | Pirani score | 61% fully corrected without residual deformity | 23% (re-plaster 24 feet) 39% (41 feet mild recurrence) | 7% (7 feet) |
Biruk 2007 [26], Ethiopia | Harrold-Walker classification | 76.8% (63 feet) No definition of complete correction. | Not reported | Not reported for Ponseti cohort |
Lavy 2007 [28], Malawi | Pirani score | 68% (327/482) Plantigrade or better | Not reported | 12 children referred for surgery |
Khan 2005 [27], South Africa | Harrold-Walker classification | 6 failures from 61 feet. Criteria for success not defined. | Not reported | Not reported |
Tindall 2005 [29], Malawi | Pirani score | 98% plantigrade foot with Pirani score | Not reported | 2% |
Mkandawire 2003 [36], Malawi | Pirani score | Correction of deformity. Success of correction defined as fitting brace. Mean Pirani score decreased from 3.6–0.86 | 4 children with untreated clubfoot, 5 with complex and 7 with teratologic | Not reported |
Process outcomes
Primary Author (Year) Country | Process Outcomes | ||||||
---|---|---|---|---|---|---|---|
Average number of casts | Duration of casts | Percutaneous Achilles Tenotomy | Receipt of braces | Brace compliance | Loss to follow up | Complications | |
Ibraheem (2017 Nigeria | 5.43 | 52 days (35–77) | 1 child did not have tenotomy, not reported case or control | 100% | Not reported | Nil | Reported no complications with swelling |
Malagelada (2016) South Africa | 8.7 (range 1–24) | Not reported | 89% (58 children) | 100% due to inclusion criteria | 2% (1 child) non-compliant | Not applicable | Defined as relapse and non-compliance: 9 children |
Smythe (2016) Zimbabwe | 7.27 (6.7–7.9) | 10.2 (9.5–10.9) weeks included tenotomy | 78.9% (127/161 children) | Not reported | Not reported | 8.9% (17 children) | Not reported |
Boakye (2016) Ghana | 4.93 | Not reported | 77% | Not reported | Not reported | Excluded from analysis | Not reported |
Adegbehingbe (2015) Nigeria | Not reported | Not reported | 77% (5626 children) | Not reported | Not reported | Not reported | Not reported |
Adweole (2014) Nigeria | 4.6 (range 3–9) | Weekly cast change, tenotomy 3 weeks | 26.6% (42 feet) | 56.8% (60 patients) | No child with relapse wore braces | Not reported | 9 feet: cast complications, blisters, ulcers, skin rash |
Ayana (2014) Ethiopia | 8 (range 6–10) | Casts changed every 2 weeks | 63.6% (14 children, 21 feet) | 100%; < 4 yrs. = FAB >4 yrs. = ankle foot orthosis | Not reported | 1 patient | No major complications |
Kouamo (2014) Togo | Not reported | Not reported | 82.9% (34/41 feet) | Not reported | Not reported | Not reported | Not reported |
Mangoli (2014) Kenya | Not reported | Not reported | Not reported | 100% of interviewed parents | 15% (33/223) non-compliant Mean use 18 months (6–23) | Not applicable | 5% (11/223) skin lesion |
Kaseke (2013) Zimbabwe | Not reported | Not reported | Not reported | Not reported | Not reported | 6 feet not reported at 6 weeks | Not reported |
Adegbehingbe (2012) Nigeria | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported |
Cashman (2012) Malawi | Not reported | Not reported | >80% | Not reported | Not reported | 107 children | Not reported |
Pirani (2012) Uganda | Not reported | Majority corrected by 6th treatment’ | Not reported | Not reported | Not reported | 83% adherence rate to end of casting | Plaster burns in 19/1000 |
Harnett (2011) Malawi | Median 5 (4–7) | 42 days (35–84) in plaster prior to tenotomy. | 52% (11 children) | Given FAB to wear until 3 years old | Not reported | 2 after plaster. 1 patient died | Not reported |
Adegbehingbe (2010) Nigeria | ≤ 6 (76.4%; range 2–6) >6 (23.6% range 7–10) | 2.3–13.7 +/−1.7 weeks | 5.5% (3 children) | Not reported | Noted as ‘generally good’ | None, not explicitly mentioned | 3.6% ugly scar, recurrence, blister, infection |
Radler (2010) Mali | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported |
Firth (2009) South Africa | 6.5 (range 2–18) | Not reported | 74% (78 feet) | Received FABs, % unspecified | 16% (11 patients) non-compliant | Not reported | 8% (9 feet) minor blistering from braces |
Biruk (2007) Ethiopia | Maximum cast 17 times | Weekly cast change | Not reported | 60%, average wait time 3-4 months | Not reported | Not reported | Not reported for Ponseti cohort |
Lavy (2007) Malawi | Not reported | Not reported | 37% had tenotomy | 44% given FABs | 44% (145/327 feet) | 32% (155 feet) | 307 adequate records |
Khan (2005) South Africa | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported |
Tindall (2005) Malawi | 5.3 | Mean treatment 9.1 weeks | 41% | All | Not reported | Not reported | 2 minor complications |
Mkandawire (2003) Malawi | Weekly cast change | Mean treatment: 7.4 weeks for idiopathic, 7.1 weeks for complex | Not reported | Not reported | Not reported | 32 patients (35%) | Not reported |