The Effect of Transportation Barriers on the Risk of Relapse for Idiopathic Clubfoot

Background: Clubfoot is a common orthopaedic birth defect and is affected by both clinical and psychosocial risk factors. The purpose of this study was to evaluate the effect of transportation barriers on the risk of relapse in patients undergoing treatment for idiopathic clubfoot. Methods: Patients diagnosed with idiopathic clubfoot were enrolled in a prospective registry at a single tertiary care center between May 2019 and August 2022. A prospective survey was administered regarding demographics and transportation, and a retrospective chart review was conducted. Zip codes were also used to query a health needs database. Results: A total of 97 patients who met inclusion criteria underwent the Ponseti treatment method, with a median of eight serial casts. Eighty patients (83.3%) underwent an Achilles tenotomy. A total of 46 patients (47.4%) experienced a relapse, and 27 patients (27.8%) experienced multiple relapses. For the first episode of relapse, 27 of 46 patients (58.7%) underwent repeat casting, 15 of 46 (32.6%) underwent a surgical procedure, and 4 of 46 (8.7%) underwent both. Patients with a longer commute to our clinic were significantly more likely to experience relapse (median 38 versus 52.5 minutes; P = 0.031). In addition, patients from areas with higher rates of households without vehicles and patients from areas with more households below the federal poverty level were more likely to experience relapse ( P = 0.008 and P = 0.037, respectively). Conclusion: Transportation barriers correlate with higher relapse rates in patients with clubfoot. These findings underscore the importance of addressing social determinants of health, particularly transportation access, to optimize treatment outcomes for patients with idiopathic clubfoot. Level of Evidence: III.