Causes of Non-Compliance and Abandonment of the Ponseti Method Related to the Abduction Splint: A Case Series Analysis
Pulido J1, Morel R2, Leal J3*, Santana A4
1Limb Lengthening and Deformity Correction Surgeon, Clínicas IDB, Barquisimeto/San Felipe, Venezuela. ORCID: 0009-0009-1626-5998.
2Limb Lengthening and Deformity Correction Surgeon, Unidad de Cirugía Ortopédica Reconstructiva de Centro-Occidente, Venezuela. ORCID: 0009 0007-4642-4959.
3Limb Lengthening and Deformity Correction Surgeon, Hospital de Niños Dr. José Manuel de los Ríos, Caracas, Venezuela. ORCID: 0009-0002-8083 6491.
4Limb Lengthening and Deformity Correction Surgeon, Centro Clínico “Leopoldo Aguerrevere”, Caracas, Venezuela. ORCID: 0009-0001-8770-8794.
*Corresponding Author: Dr. Juan Leal, Hospital de Niños Dr. José Manuel de los Ríos, 4th Floor, Av. Vollmer, San Bernardino, Caracas, Venezuela.
https://doi.org/10.58624/SVOAOR.2026.06.011
Received: May 26, 2026
Published: June 18, 2026
Citation: Pulido J, Morel R, Leal J, Santana A. Causes of Non-Compliance and Abandonment of the Ponseti Method Related to the Abduction Splint: A Case Series Analysis. SVOA Orthopaedics 2026, 6:3, 78-84. doi: 10.58624/SVOAOR.2026.06.011
Abstract
Background: The Ponseti method is widely recognized as the gold standard for congenital clubfoot correction. However, treatment protocol disruption during the abduction splint phase remains the primary risk factor for deformity relapse.
Objective: To determine the causes of abandonment of the treatment of clubfoot with the Ponseti method during the use of the abductor splint.
Material and Methods: A retrospective case series study (Level of Evidence IV) was conducted. Medical records from a total pool of 71 patients treated with the Ponseti method were screened. After applying strict exclusion criteria (incomplete records, non-Ponseti protocols, or abandonment prior to the splint phase), 7 referred/external patients with secondary congenital clubfoot recurrence due to treatment non-compliance were selected and analyzed.
Results: Bilateral involvement was present in 72% of the sample, with a marked male predominance (86%). The age of recurrence peaked between 1 and 3 years (43% each). Two primary categories for treatment abandonment were identified according to the original protocol: (a) Non-compliance with the abduction splint (71.4%), driven by parental non-compliance (42.9%; protocol misunderstanding, lack of perceived importance, and child splint intolerance) and poor medical orientation (28.6%). (b) Abduction splint structural deficiencies (28.6%), driven by technical errors in design and improper orthotic sizing. Overall, parental factors accounted for 42.9% and medical/technical management errors accounted for 57.1% of the relapses.
Discussion: Relapse in a previously well-corrected foot is strongly tied to poor brace compliance. While parental compliance is deeply influenced by socioeconomic and cultural factors, a significant portion of treatment failures stems from inadequate medical communication and technical follow-up. Comprehensive pre-brace family education and professional orthotic surveillance are vital to prevent recurrence.
Keywords: Clubfoot; Recurrence; Abduction splint; Ponseti method; Treatment refusal; Evidence Level IV.