The Clinical Effectiveness of the Dennis Brown Splint for the Management of Idiopathic Clubfoot in the Eastern Cape: A Retrospective Cohort Clinical Evaluation

Background/Objectives: Congenital Talipes Equinovarus (CTEV) is a prevalent musculoskeletal deformity requiring precise management to prevent lifelong disability. While the Ponseti method and Dennis Brown Splint (DBS) are global standards, relapse remains a critical challenge in resource-constrained regions like the Eastern Cape. This study aimed to evaluate the clinical effectiveness of the DBS in maintaining foot correction, preventing relapse, and promoting functional mobility in paediatric patients post-Ponseti treatment at two Eastern Cape hospitals. Methods: A retrospective clinical evaluation was conducted of the medical records of 33 paediatric patients (51 feet) aged 2–12 months, diagnosed with idiopathic clubfoot. Participants were sampled from Frere Tertiary Hospital (n=23) and Bedford Orthopaedic Hospital (n=10). Outcome measures included changes in Pirani scores and goniometric dorsiflexion angles. Adherence was categorised by follow-up frequency, and qualitative clinical notes were reviewed to identify systemic barriers to successful bracing. Results: The Frere Hospital cohort showed a statistically significant improvement in Pirani scores, decreasing from a mean of 4.20 (±0.90) to 0.59 (±0.47) (p < 0.001), with a relapse rate of 13%. In contrast, the Bedford Hospital cohort exhibited non-significant improvements and a 50% relapse rate. Adherence was strongly associated with outcomes; patients with high follow-up frequency achieved significantly better correction. Systemic factors, including fitting errors and supply chain issues, were identified as primary drivers of poor outcomes. Conclusions: The DBS is biomechanically effective for maintaining correction, but its clinical success is highly contingent on systemic support, practitioner expertise, and caregiver adherence.