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Purpose <p>To develop evidence-based consensus guidelines for idiopathic clubfoot treatment in children by integrating a comprehensive evidence synthesis with expert consensus.</p> Methods <p>We performed a PRISMA-compliant umbrella review of published systematic reviews, meta-analyses, and clinical guidelines on idiopathic clubfoot management. Inclusion criteria covered any intervention and outcomes for idiopathic clubfoot. Two reviewers independently screened studies and assessed quality using the Joanna Briggs Institute checklist. Data were extracted and qualitatively synthesized due to heterogeneity, grouping evidence by clubfoot type, treatment modality, and outcome domain. A 25-member expert panel then formulated consensus recommendations via a modified Delphi process (two survey rounds and a final consensus meeting) with a 75% agreement threshold.</p> Results <p>A total of 47 publications met inclusion (41 systematic reviews and 6 guidelines). Most included reviews were of moderate quality on JBI assessment. The evidence confirmed the Ponseti serial casting method as the gold-standard for idiopathic clubfoot. Ponseti casting achieved pooled initial correction rates of 96–98%, with relapse in 20–30%. It significantly outperformed older methods: relapse risk was roughly halved versus Kite’s casting, and Ponseti yielded better long-term outcomes than extensive surgery (73% vs. 62% good/excellent results) while drastically reducing the need for major surgical release. In non-idiopathic (syndromic/neurogenic) clubfoot, Ponseti still attained 91% initial correction but only 68% long-term success due to higher relapse (30–40%). The Delphi panel reached consensus on 14 statements reflecting these findings. Key recommendations include initiating Ponseti treatment within the first 2–6&#xa0;weeks of life, using Achilles tenotomy and bracing to maintain correction, reserving extensive surgery for only refractory cases, managing relapses with repeat casting and limited surgery, ensuring long-term follow-up, and promoting standardized Ponseti training.</p> Conclusion <p>Combining a rigorous umbrella review with Delphi consensus yielded robust, evidence-informed guidelines. The CPAM-LRC consensus confirms Ponseti as first-line treatment and provides an expert-endorsed framework for adjunct interventions and follow-up, which should improve the consistency and outcomes of idiopathic clubfoot care.</p>

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Management of idiopathic clubfoot: an umbrella review and CPAM-LRC consensus: Limb Reconstruction Committee of Orthopedics Branch of China International Exchange and Promotion Association for Medical and Health Care (CPAM-LRC)

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年11月26日

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  • Fei Zhao,
  • Tianyi Wu,
  • Qinglin Kang,
  • Chen Wang,
  • Xiang Geng,
  • Hui Qin,
  • Yan Zhang,
  • Chi Su,
  • Hui Wang,
  • Jin He,
  • Haiyan Wang,
  • Lihua Huang,
  • Shengdi Lu,
  • Jia Xu

摘要

Purpose

To develop evidence-based consensus guidelines for idiopathic clubfoot treatment in children by integrating a comprehensive evidence synthesis with expert consensus.

Methods

We performed a PRISMA-compliant umbrella review of published systematic reviews, meta-analyses, and clinical guidelines on idiopathic clubfoot management. Inclusion criteria covered any intervention and outcomes for idiopathic clubfoot. Two reviewers independently screened studies and assessed quality using the Joanna Briggs Institute checklist. Data were extracted and qualitatively synthesized due to heterogeneity, grouping evidence by clubfoot type, treatment modality, and outcome domain. A 25-member expert panel then formulated consensus recommendations via a modified Delphi process (two survey rounds and a final consensus meeting) with a 75% agreement threshold.

Results

A total of 47 publications met inclusion (41 systematic reviews and 6 guidelines). Most included reviews were of moderate quality on JBI assessment. The evidence confirmed the Ponseti serial casting method as the gold-standard for idiopathic clubfoot. Ponseti casting achieved pooled initial correction rates of 96–98%, with relapse in 20–30%. It significantly outperformed older methods: relapse risk was roughly halved versus Kite’s casting, and Ponseti yielded better long-term outcomes than extensive surgery (73% vs. 62% good/excellent results) while drastically reducing the need for major surgical release. In non-idiopathic (syndromic/neurogenic) clubfoot, Ponseti still attained 91% initial correction but only 68% long-term success due to higher relapse (30–40%). The Delphi panel reached consensus on 14 statements reflecting these findings. Key recommendations include initiating Ponseti treatment within the first 2–6 weeks of life, using Achilles tenotomy and bracing to maintain correction, reserving extensive surgery for only refractory cases, managing relapses with repeat casting and limited surgery, ensuring long-term follow-up, and promoting standardized Ponseti training.

Conclusion

Combining a rigorous umbrella review with Delphi consensus yielded robust, evidence-informed guidelines. The CPAM-LRC consensus confirms Ponseti as first-line treatment and provides an expert-endorsed framework for adjunct interventions and follow-up, which should improve the consistency and outcomes of idiopathic clubfoot care.