Abstract

Clubfoot (congenital talipes equinovarus) is one of the most common congenital lower limb deformities worldwide, affecting approximately 1-2 per 1,000 live births. In Pakistan, an estimated 6,000-7,000 children are born with clubfoot annually. The Ponseti method, a non-surgical approach involving sequential casting, Achilles tenotomy, and prolonged bracing for up to four to five years, has a success rate of 68-95% when parents adhere fully. However, in low-resource settings like rural Pakistan, treatment outcomes are often compromised by poor parental knowledge, inadequate awareness, and suboptimal compliance. This descriptive cross-sectional study was conducted at Bacha Khan Medical Complex, Swabi, to assess parental knowledge regarding the causes and treatment of clubfoot, evaluate awareness after counseling about the Ponseti method, and determine compliance with casting, bracing, and follow-up visits. Parents of 34 children under five years of age with idiopathic clubfoot were interviewed using a structured, pretested questionnaire. Data were analyzed using SPSS version 25; frequencies, percentages, and chi-square tests were applied. The results showed that 61.8% of affected children were male, and 82.4% lived in rural areas. Overall, 70.6% of parents did not know the cause of clubfoot, and only 23.5% correctly identified it as congenital. Encouragingly, 82.4% believed clubfoot is treatable. Although 79.4% reported receiving full counseling, only 64.7% understood the importance of the brace, and just 29.4% knew the correct brace duration (until age four). Compliance with weekly cast changes was 73.5%, and good brace usage was reported by 64.7%. Major barriers to adherence included financial constraints (11.8%) and work commitments (11.8%). Higher parental education was significantly associated with better knowledge of treatment options (p=0.003) and awareness of brace protocol (p=0.001). In conclusion, despite reasonable access to treatment, significant gaps exist in parental knowledge and compliance, particularly regarding brace duration. Repeated, literacy-sensitive counseling and visual aids are urgently needed to improve long-term adherence and reduce relapse rates..