Aims Clubfoot is the most common congenital foot deformity. Although the overall effectiveness of the Ponseti method is well established, it has traditionally been taught as a unified doctrine, and individual components, particularly those related to the maintenance of correction, have not been evaluated with the same level of rigour. Consequently, high-quality evidence to support clinical decision-making remains limited. This study used a consensus-based approach to identify research priorities for clinical trials in clubfoot management. Methods This study followed a previously published protocol. A modified Delphi technique was used, which involved an initial scoping survey, a two-round modified Delphi consensus survey, and consensus meetings that included the UK Clubfoot Network Research Committee. The survey was distributed among key stakeholders in the management of clubfoot as well as patients and carers in the UK. Reporting followed the ACCORD checklist. Results A total of 103 and 93 participants contributed to rounds one and two of the Delphi process, respectively, scoring research priorities from one (low priority) to five (high priority). Stakeholders identified nine priorities in research across four themes of Primary Treatment, Bracing, Relapse, and Physiotherapy. The highest scoring themes were Relapse and Bracing, and the highest scoring priority was regarding the effectiveness of unilateral versus bilateral bracing. Conclusion Identification of research priorities in clubfoot through this study will guide multicentre clinical trials to improve evidence-based clubfoot treatment.

Rehm, Andreas; Osman, Hatem; Newton, Ayla C.; Clegg, Rachael; Ashby, Elizabeth; Chase, Helen E. Author Information

The objective of this inclusive literature review is to identify surgeries performed for Freiberg's disease (FD) and their outcomes and to perform the first population-based study to establish its incidence. We reviewed all retrievable publications linked to FD listed in PubMed and publications quoted within these publications going back to 1914. Patients with FD and the number of livebirths born in our maternity hospital between 2000 and 2023 were identified from our hospital database. We identified 208 publications of which we managed to review 163 (1121 patients, 1169 feet, of which 939 feet underwent surgery, 116 had no surgery, and for 114, it was unknown if surgery was performed. Patient age: 194 × <18 years, 516 × ≥18 years, 411 × age unknown). The most frequently performed surgeries were intra-articular closing wedge metatarsal osteotomies through the defect (IDCWMO) (284 feet), extra-articular dorsal closing wedge metatarsal osteotomies (EDCWMO) (118 feet), osteochondral autologous transplantation (OAT) (64 feet), and modified Weil osteotomies with intra-articular dorsal closing wedge osteotomies (52 feet). Outcome scores were used in 39 publications, with the American Orthopaedic Foot and Ankle Society score having been used most frequently (28 studies, 462 patients, 482 feet). The mean scores were excellent for OATs and EDCWMOs and good for IDCWMOs and modified Weil osteotomies. We identified 124 644 livebirths and 44 patients with FD. In conclusion, multiple procedures achieved a high rate of excellent and good outcomes where nonoperative management failed. FDis rare, with an extrapolated incidence of 1 in 2833 livebirths.

The objective of this study is to identify musculoskeletal manifestations associated with Stickler syndrome from an inclusive literature review and to perform the first population study to establish its incidence. We reviewed all for us retrievable publications linked to Stickler syndrome listed in PubMed and publications quoted within these publications going back to 1954. From our medical record data bases, we identified all patients with the diagnosis of Stickler syndrome out of a population of consecutive live births born in our maternity hospital between 2000 and 2016. We identified 504 publications of which we managed to obtain and review 487, listing 6182 patients with Stickler syndrome. Musculoskeletal manifestations were recorded in 161 publications (2157 patients: 649 children, 931 adults, unknown 577), providing information on musculoskeletal findings for 1738 patients. There were 237 lower limb-, 233 spinal- and 80 upper limb abnormalities recorded for children. Hyperlaxity was recorded for 100 and unspecified pain for 70 children and for 77 abnormalities it was not specified if upper or lower limbs were affected. Coronal and axial lower limb malalignment was documented 74 times. We identified four patients with Stickler syndrome out of 87 378 consecutive live births, giving an incidence of 1 in 21 844 live births. Patients with Stickler syndrome present with a large variety of musculoskeletal manifestations. Assessment by a paediatric orthopaedic surgeon in childhood would be beneficial to identify spinal abnormalities and alignment problems, such as coxa vara/valga, abnormal femoral version, genu valgum and distal lateral tibial dysplasia, where guided growth or osteotomies might be useful to alleviate future function and symptoms.

Rehm, Andreas MD; Worley, Rebecca J. MBBS BSc; Osman, Hatem MBBCh, MSc; Gompels, Ben MBBCh; Chase, Helen E. MBBCh, FRCS Tr&Ortho; Ashby, Elizabeth MD Author Information

Aims:Clubfoot is the most common congenital foot deformity. Clubfoot management is lacking high-quality research to support clinical decision-making. It has been chosen as one of the elective priorities in research by the James Lind Alliance priority setting. We present the protocol of a consensus-based approach to identify research priorities for clinical trials in clubfoot management. Methods:A modified Delphi technique will be used, which will involve an initial scoping survey, a two-round Delphi process, and a consensus meeting. The survey will be conducted among key stakeholders in the management of clubfoot, as well as patients and carers in the UK. The priorities identified during this process will each be assigned to core areas of consideration. The final list of research priorities will then be discussed and agreed in a consensus meeting of representative key stakeholders. Conclusion:While treatment of clubfoot has become more consistent with the use of the Ponseti method, most research is retrospective from single centres, and outcomes are variable. Identifying research priorities in this group of patients through this study will shape and drive the development of multicentre prospective clinical trials deemed most important for improving clinical practice and health outcomes.