Factors associated with failure of Ponseti treatment for congenital Clubfoot in a resource-limited setting: A multicentric analytical study in Katanga (DRC)

Purpose To identify determinants of Ponseti treatment failure for idiopathic congenital talipes equinovarus (CTEV) in a resource-limited setting. Methods A multicentric analytic observational study was conducted in three hospitals in Katanga, democratic republic of Congo (DRC) between January 2024 and September 2025, including 129 children with idiopathic CTEV, with 109 complete cases analysed. Clinical, socioeconomic and family data were gathered via records and interviews. Multivariable logistic regression was used to identify factors predictive of treatment failure (defined as non-plantigrade foot requiring retreatment). Results Failure was associated with urban residence (aOR 14.3), family history of clubfoot (aOR 46.7), and being treated by general practitioners (aOR 14.0; p = 0.048) or nurses (aOR 74.5; p = 0.013) rather than orthopaedists. Financial barriers remained predominant. Conclusion In resource-limited settings, failures are mainly due to organizational and socioeconomic factors, highlighting the need for specialized training, family support, and decentralized care.