Hidden Economic and Social Costs of Clubfoot Treatment Using the Ponseti Method in Indiana

BACKGROUND: Care for the treatment of talipes equinovarus (TEV) is challenging in many regions of the United States. This study examines these challenges, focusing on travel distances and travel costs during the initial Ponseti treatment. METHODS: This was a 2-part study. Part 1 was a retrospective review of demographic data (September 2021 to August 2022) of 74 TEV patients. The number of appointments, travel distances, and Area Deprivation Index (ADI) deciles were assessed, resulting in a calculation of noninsured costs in US$. The second part was a prospective study of 91 patients (September 2023 to January 2025); the same calculations were performed, as well as administration of a patient questionnaire delving into challenges faced by the patients' families. RESULTS: Part 1: The average driving distance was 899 miles. The median estimated costs not covered by insurance were $2462, or 4.0% of the median household income. Part 2: The average driving distance was 1040 miles. The median estimated costs not covered by insurance was $2691 or 3.5% of the median household income. There were no patient-initiated appointment changes in 47 patients, 1 in 28 patients, 2 in 10 patients, 3 in 2 patients, 4 in 3 patients, and 5 in 1 patient. Questionnaire results demonstrated no differences between low and high deprivation ADI groups except for cast issues with the lower deprivation group needing to return more frequently. Seven (8%) families obtained a hotel room and 42 (46%) needed another family member for childcare; another 8 (9%) brought their other children with them to the visits. For firstborn children, 23% of the families enlisted the assistance of other family members, and this was 74% when the patient was not a firstborn. CONCLUSIONS: Considerable financial burden associated with clubfoot treatment exists in the US. Travel distances, associated with other costs, and the low numbers of pediatric orthopaedic surgeons, results in substantial time and financial burden to families. This highlights the need for solutions to reduce these costs. LEVEL OF EVIDENCE: Level II.