comparing clubfoot treatment using ponseti casting at weekly versus biweekly intervals in infants

Background: clubfoot is a common congenital deformity in infants that, if left untreated, can lead to pain, deformity, and gait abnormalities. the ponseti method is traditionally applied with weekly cast changes. however, frequent hospital visits can pose challenges for families, especially those traveling long distances. objectives: this study aims to evaluate the effectiveness of applying ponseti casting at biweekly intervals compared to the standard weekly approach.methods: this randomized clinical trial was conducted from 2024 to 2025 at the orthopedic clinics of hazrat rasool akram and hazrat ali asghar hospitals, tehran city, iran. infants diagnosed with idiopathic congenital clubfoot were enrolled, while those with secondary clubfoot due to syndromic or neurologic conditions (e.g. arthrogryposis) were excluded. participants were randomized to receive ponseti casting either weekly or biweekly. a total of 73 patients (114 feet) were included and evaluated using the pirani scoring system.results: finally, both groups showed a significant reduction in pirani scores post-treatment (p<0.05), indicating clinical improvement. however, there was no statistically significant difference in final pirani scores between the weekly and biweekly groups (p=0.791). the biweekly group required significantly fewer total casting sessions compared to the weekly group (p<0.05).conclusion: this study demonstrates that biweekly casting intervals can achieve comparable clinical outcomes to weekly casting while reducing the total number of casting sessions. this approach may be particularly beneficial for patients facing logistical or financial challenges in accessing frequent care.