Early clinical outcomes of a novel casting technique based on the Ponseti method for idiopathic clubfoot: a retrospective comparative study

The Ponseti method is a recommended treatment for infantile clubfoot, but conventional casting usually requires one operator to hold the correction and another to apply the cast. This requirement can limit treatment efficiency in high-volume or resource-limited settings. We evaluated the early clinical outcomes of a one-operator figure-of-eight casting technique using semirigid synthetic softcast (SSS), designed according to Ponseti correction principles. We retrospectively reviewed infants with congenital idiopathic clubfoot treated at two tertiary pediatric orthopedic centers. The novel casting group included patients treated with the SSS figure-of-eight technique from January 2022 to May 2026. The standard group included patients treated with standard Ponseti casting using plaster of Paris from January 2013 to May 2026. Baseline characteristics, Pirani scores, number of casts, Achilles tenotomy and cast-related complications were compared between groups. Analyses were performed at the patient or foot level according to the outcome type. The standard group included 156 patients (215 feet), and the novel casting group included 18 patients (22 feet). Except for the follow-up duration, the other baseline characteristics did not differ significantly between groups. In the novel casting group, the mean initial and post-treatment Pirani scores were 5.07 ± 0.64 and 0.18 ± 0.36, respectively, and the mean number of casts was 5.14 ± 0.77. In the standard group, the corresponding values were 5.23 ± 0.58, 0.27 ± 0.42, and 4.91 ± 0.86. Achilles tenotomy was performed in 95.45% of feet in the novel casting group and 93.49% of feet in the standard group. There were no significant differences between the two groups in initial and post-treatment Pirani scores, the number of casts, or the tenotomy rate. All feet in both groups achieved initial correction. Cast-related complications occurred in 13.64% of feet in the novel casting group and 28.84% of feet in the standard group, without a statistically significant difference. The SSS-based one-operator figure-of-eight casting technique was feasible and achieved satisfactory early correction in this small retrospective cohort of infants with idiopathic clubfoot. These preliminary findings support further evaluation of the technique as a practical casting approach when an assistant is not readily available. However, the small sample size, cross-center design, differences in casting material and treatment period, and unequal follow-up preclude conclusions regarding comparative efficacy, complication risk, or long-term durability. Further prospective studies are required to determine the safety, reproducibility, and independent clinical effect of this technique.