Prognostic Determinants of Relapse Following the Ponseti Method for Congenital Talipes Equinovarus (CTEV): A Systematic Review and Meta-Analysis

Background/Objectives: Congenital talipes equinovarus (CTEV) is a common congenital musculoskeletal deformity treated primarily by the Ponseti method, yet relapse remains a significant clinical challenge. This systematic review and meta-analysis aimed to identify and quantify predictor factors for relapse following Ponseti treatment. Methods: Three major electronic databases were searched systematically following PRISMA guidelines. Studies reporting relapse as an outcome with at least one prognostic factor in idiopathic CTEV patients treated by the Ponseti method were included. Data were pooled using random-effects meta-analysis, with odds ratios for categorical predictors and standardized mean differences for continuous variables. Results: Fifteen studies comprising 1313 patients and 1963 clubfeet were included. The pooled relapse proportion was 20.9% (95% CI: 16.5–25.5%). Brace non-compliance was the strongest predictor of relapse (pooled OR: 12.55, 95% CI: 1.51–104.39, p = 0.019). Higher baseline Pirani score was significantly associated with relapse (SMD: 0.49, 95% CI: 0.17–0.82, p = 0.003). Laterality (OR: 1.30, 95% CI: 0.64–2.64, p = 0.464) and age at treatment initiation (OR: 0.99, 95% CI: 0.35–2.80, p = 0.987) were not significant predictors. Among relapsed cases, repeat casting was performed in 73.6% (95% CI: 52.9–94.2%), tibialis anterior tendon transfer in 22.0% (95% CI: 13.7–30.2%), and posteromedial release in 12.9% (95% CI: 5.9–20.0%). Conclusions: Brace non-compliance and higher initial deformity severity are the principal modifiable and prognostic predictors of CTEV relapse following Ponseti treatment and must be central to individualized risk stratification and parental counseling.