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World J Meta-Anal. Jun 18, 2026; 14(2): 118716
Published online Jun 18, 2026. doi: 10.13105/wjma.v14.i2.118716
Published online Jun 18, 2026. doi: 10.13105/wjma.v14.i2.118716
Paradigm shift in clubfoot care strategies in Pakistan: A meta-analysis over three decades
Anisuddin Bhatti, Saddam Mazar Baloch, Department of Orthopedic and Spine Surgery, Dr. Ziauddin University Hospital, Clifton, Karachi 75510, Sindh, Pakistan
Jose Antonio Morcuende, Department of Orthopedic Surgery and Rehabilitation, University of Iowa, Iowa, IA 52242, United States
Kiran Jaffri, Department of Orthopedic Surgery, Sindh Government 50-bed Hospital, Landhi, Karachi 75160, Sindh, Pakistan
Muhammad Yousuf Bhatti, Department of Orthopedic Surgery, Jinnah Postgraduate Medical Centre, Karachi 75510, Sindh, Pakistan
Author contributions: Bhatti A contributed to concept and design of the work, data acquisition, analysis, interpretation, drafting the manuscript, and critical revision for important intellectual content; Baloch SM contributed to data extraction, data analysis, and drafting results, discussion, statistical analysis; Morcuende JA contributed to concept design, critical review of results, arbitrator for disagreement and revising manuscript; Jaffri K and Bhatti MY contributed to data extraction, sequence synthesis, tabulation, manuscript review. All authors have read and approved the final manuscript. And agree to be accountable for all aspects of the work.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Saddam Mazar Baloch, MD, Assistant Professor, Consultant, Department of Orthopedic and Spine Surgery, Dr. Ziauddin University Hospital, 4/B Shahrah-e-Ghalib Rd, Block 6 Clifton, Karachi 75600, Sindh, Pakistan. drmazar@gmail.com
Received: January 9, 2026
Revised: February 24, 2026
Accepted: May 20, 2026
Published online: June 18, 2026
Processing time: 154 Days and 14 Hours
Revised: February 24, 2026
Accepted: May 20, 2026
Published online: June 18, 2026
Processing time: 154 Days and 14 Hours
Core Tip
Core Tip: This meta-analysis synthesizes 35 years of clubfoot management literature from Pakistan, documenting a complete paradigm shift from predominantly surgical approaches (pre-2005) to the Ponseti method as the dominant strategy (96% adoption by 2025). Pooled short-term success reached 87.2% (approaching global benchmarks of 90%-95%), with referral age declining to 6.3 months, highlighting the impact of national training programs. However, very short follow-up (mean 1.8 years) represents a major limitation, as global evidence shows relapse rates rise significantly after age 4-5 years, emphasizing the need for long-term studies to confirm durable correction in resource-limited settings.