Qualitative assessment of the challenges to the treatment of idiopathic clubfoot by the Ponseti method in urban India.

The Ponseti method of clubfoot treatment has been shown to be a very safe, effective and minimally invasive technique when performed in medical centers in Europe and North America. However, only a limited number of studies have helped identify the challenges for effective treatment with the Ponseti method in India. In this study a qualitative approach was used through distribution of questionnaires, personal interviews and focus groups with orthopedic surgeons (in urban centers) and parents of patients with clubfoot. The following factors were evaluated: (i) physician education, (ii) alternative methods of treatment/modification of the Ponseti technique, (iii) compliance by parents, (iv) treatment in underserved areas, (v) culture, (vi) community knowledge of clubfoot, and (vii) the health care system in India. The results showed that all of the factors evaluated hindered outcomes for patients; however, parent's compliance with bracing, lack of proper rural clubfoot treatment clinics, poverty and physician education were the most prominent challenges. The results of this study can be used to implement specific strategies to improve the diffusion and implementation of the Ponseti method for treating clubfoot throughout India.