EFFECTIVENESS OF ADJUNCTIVE PRE-CASTING PHYSIOTHERAPY IN PONSETI MANAGEMENT OF CONGENITAL CLUBFOOT: SYSTEMATIC REVIEW AND META-ANALYSIS OF CASTING EFFICIENCY AND BURDEN REDUCTION.
DOI:
https://doi.org/10.71146/kjmr930Keywords:
Clubfoot, Ponseti method, pre-casting physiotherapy, casting burden, LMICAbstract
Background: Congenital talipes equinovarus (clubfoot/CTEV) affects 1.2/1,000 live births globally, rising to 2.1/1,000 in Pakistan. Ponseti method casting phase (5-7 casts, 4-9 weeks) imposes substantial LMIC burden (40-70% attrition), particularly Pakistan's 20,000 annual cases where transport/costs cause default cascade. Pre-casting physiotherapy (7-14 days manual stretching before first cast) may reduce rigidity and casting burden.
Objective: Evaluate adjunctive pre-casting physiotherapy effectiveness vs standard Ponseti casting for idiopathic CTEV infants ≤6 months, focusing total casts required (primary) and time/ Pirani/ tenotomy/ relapse rates (secondary).
Methods: PRISMA 2020 systematic search (inception-Jan 2026) across PubMed, Embase, Cochrane CENTRAL, Scopus, PEDro, PakMediNet, and IMEMR identified RCTs/prospective cohorts. Dual screening/extraction (Covidence), RoB 2/NOS assessment, random-effects meta-analysis (RevMan 5.4), GRADE certainty evaluation.
Results: 12 studies (1,486 feet; 762 intervention, 724 control) included. Pre-casting physiotherapy significantly reduced total casts (MD -1.47, 95% CI -1.89 to -1.05, p<0.001, I²=42%; moderate certainty), correction time (MD -6.3 days), Pirani improvement (MD -0.59 points), tenotomy (RR 0.88, NNT=18), relapse (RR 0.82). LMIC subgroup MD -1.58 casts. No increased adverse events.
Conclusion: Moderate certainty evidence supports 10 day precasting physiotherapy integration into Pakistan Ponseti protocols, yielding 25% casting reduction (PKR 3,750/case savings), 750% ROI. National PPTA/Orthopedic Association endorsement recommended with pragmatic dose-optimization RCT (7 vs. 10 vs. 14 days).
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Copyright (c) 2026 Muhammad Tahir Akram, Wasif Masood, Dr. Sobia Meeran (PT), Jawairia Jawaid, Sultan Ali Sattani, Dr. Kiran Mujahid, Eraj Fatima (Author)
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