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Jiratummarat P, Osateerakun P, Tooptakong T, Limpaphayom N. Comparison of kinematics and pedobarography findings between the unaffected foot of patients with unilateral clubfoot and controls. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06219-z. [PMID: 38758492 DOI: 10.1007/s00264-024-06219-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Idiopathic clubfoot (ICF) involves structural abnormalities in the lower extremities. Approximately half of patients have unilateral ICF, which could be due to differences in limb formation. The contralateral unaffected foot may have subclinical ICF. The objectives were to compare ankle and foot kinematics and pedobarography findings between the unaffected foot of patients with unilateral ICF and controls. METHODS Eleven children with unilateral ICF (11 unaffected feet, 11.7 ± 3.8 years) and 15 age-matched controls (30 control feet, 11.1 ± 3.0 years) were enroled. Five complete gait trials were performed. Data were collected using ten cameras and a two m long Footscan system and compared between groups using the Wilcoxon rank sum test. RESULTS All children with ICF underwent the selective soft tissue release procedure. The unaffected feet showed limited ranges in inversion-eversion and dorsiflexion-plantar flexion on kinematic analysis. There was a delay in landing time in all regions of the foot during heel rise and propulsion. The peak time was achieved significantly later in the unaffected feet compared to the controls. Although plantar pressure parameters were comparable, unaffected feet showed a larger contact area in the midfoot region. CONCLUSIONS Gait data on the unaffected foot in unilateral ICF patients do not correspond to those of controls despite an indistinguishable clinical appearance. This could be due to the effect of treatment, the process of foot development, or a combination. The relationship between genetics and gait deviation in patients with unilateral ICF needs further evaluation. The unaffected foot should receive similar attention during follow-up.
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Affiliation(s)
- Prajak Jiratummarat
- Department of Orthopaedics, Panyananthaphikkhu Chonprathan Medical Center, Srinakarinwirot University, Nonthaburi, 11120, Thailand
| | - Phatcharapa Osateerakun
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Excellence Center for Gait and Motion, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Tanteera Tooptakong
- Bangbuathong Hospital, Ministry of Public Health, Nonthaburi, 11110, Thailand
| | - Noppachart Limpaphayom
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
- Excellence Center for Gait and Motion, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand.
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Wijnands SDN, Grin L, van Dijk LS, Besselaar AT, van der Steen MC, Vanwanseele B. Clubfoot patients show more anterior-posterior displacement during one-leg-standing and less ankle power and plantarflexor moment during one-leg-hopping than typically developing children. Gait Posture 2024; 108:361-366. [PMID: 38227996 DOI: 10.1016/j.gaitpost.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND Clubfoot patients show good-to-excellent foot correction after the Ponseti method. Nevertheless, underlying functional problems that limit motor abilities such as one-leg-standing and one-leg-hopping still persist. These restrictions have been proposed to arise due to problems with maintaining balance and the limited force-generating capacity of clubfoot patients. More insight is needed to understand the underlying limiting factors to improve overall motor ability in clubfoot patients. RESEARCH QUESTION The aim of this study was to determine the differences between clubfoot patients and typically developing children (TDC) in force and balance parameters during walking, one-leg-standing and hopping. METHODS Three-dimensional motion analysis was performed in 19 TDC and 16 idiopathic Ponseti-treated clubfoot patients between 5-9 years old. Kinematic and kinetic parameters were calculated during walking and one-leg-hopping. To describe the balance parameters, center of pressure (CoP) data was assessed during walking, one-leg-hopping and one-leg-standing. Mean group values were calculated and compared using nonparametric statistical tests. A general linear model with repeated measures was used to determine which activity showed the largest group differences. RESULTS Clubfoot patients showed lower peak plantarflexor moment and peak ankle power absorption and generation during one-leg-hopping compared to TDC. Furthermore, clubfoot patients showed a lower hop length and velocity than TDC. The difference in peak plantarflexor moment and ankle power between the study groups was larger during one-leg-hopping than during walking. Finally, clubfoot patients showed a higher anterior-posterior CoP range during one-leg-standing. SIGNIFICANCE Deviations in force parameters seemed to limit one-leg-hopping in clubfoot patients, and impaired anterior-posterior static balance was thought to be the underlying cause of problems with one-leg-standing. Furthermore, one-leg-hopping was more sensitive to distinguish between clubfoot patients and TDC than walking. Individualized physiotherapy targeting static balance and force parameters, with extra emphasis on including eccentric contractions, might improve the overall motor abilities of clubfoot patients.
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Affiliation(s)
- S D N Wijnands
- Human Movement Biomechanics Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Postbus 550, 3000 Leuven, Belgium; Department of Orthopaedic Surgery & Trauma, Máxima MC, Postbus 90052, 5600 PD Eindhoven, the Netherlands
| | - L Grin
- Human Movement Biomechanics Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Postbus 550, 3000 Leuven, Belgium; Fontys University of Applied Sciences, Postbus 347, 5612 MA Eindhoven, the Netherlands.
| | - L S van Dijk
- Fontys University of Applied Sciences, Postbus 347, 5612 MA Eindhoven, the Netherlands
| | - A T Besselaar
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Postbus 90052, 5600 PD Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, the Netherlands
| | - M C van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Postbus 90052, 5600 PD Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, the Netherlands
| | - B Vanwanseele
- Human Movement Biomechanics Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Postbus 550, 3000 Leuven, Belgium; Fontys University of Applied Sciences, Postbus 347, 5612 MA Eindhoven, the Netherlands
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Grin L, van Oorschot L, Vanwanseele B, Wijnands SDN, Kars HJJC, Besselaar AT, van der Steen MCM. Kinematic Gait Impairments in Children with Clubfeet Treated by the Ponseti Method: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050785. [PMID: 37238333 DOI: 10.3390/children10050785] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Being aware of possible gait impairments in Ponseti-treated clubfoot children might be useful for optimizing initial and additional treatment. Therefore, this systematic review and meta-analysis aimed to identify kinematic gait abnormalities in children with clubfoot treated with the Ponseti method (with and without relapse). METHODS A systematic search was conducted. Studies comparing kinematic gait parameters of Ponseti-treated clubfoot children to healthy controls were included. Meta-analyses and qualitative analyses were conducted on the extracted data. RESULTS Twenty studies were identified. Twelve of the 153 reported kinematic outcome measures could be included in the meta-analysis. Plantarflexion at push-off, maximum ankle dorsiflexion during the swing, maximal plantarflexion, and ankle range of motion was significantly lower in Ponseti-treated clubfoot children. Ponseti-treated clubfoot children showed more internal foot progression. Qualitative analysis revealed 51 parameters in which pre-treatment relapse clubfeet deviated from healthy controls. CONCLUSIONS Ponseti-treated clubfoot children showed several kinematic gait differences from healthy controls. In future studies, homogeneity in measured variables and study population and implementation of multi-segmental foot models will aid in comparing studies and understanding clubfoot complexity and treatment outcomes. The question remains as to what functional problems gait impairments lead to and whether additional treatment could address these problems.
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Affiliation(s)
- Lianne Grin
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, The Netherlands
- Department of Movement Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium
| | - Lisa van Oorschot
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, The Netherlands
| | - Benedicte Vanwanseele
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, The Netherlands
- Department of Movement Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium
| | - Saskia D N Wijnands
- Department of Movement Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, 5600 PD Eindhoven, The Netherlands
| | - H J J Cojanne Kars
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, The Netherlands
| | - Arnold T Besselaar
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, 5600 PD Eindhoven, The Netherlands
| | - M C Marieke van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, 5600 PD Eindhoven, The Netherlands
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, 5602 ZA Eindhoven, The Netherlands
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Participation and Motor Abilities in Children Aged 5 to 9 Years With Idiopathic Clubfeet After Treatment With the Ponseti Method. J Pediatr Orthop 2023; 43:e36-e42. [PMID: 36253894 DOI: 10.1097/bpo.0000000000002278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Functioning in children consists of different aspects, including their ability to execute activities and participate in life situations. Several studies on children with clubfeet showed limited motor abilities and walking capacity compared with healthy control children, while other studies showed comparable athletic abilities and gross motor development. Although participation in activities of daily life plays an important role in the development of children, this has not yet been investigated in children with clubfeet. The study aims to determine the level of parents' perceived motor ability and participation in Ponseti-treated children with clubfeet compared with age-matched healthy controls. METHODS Parents of children aged 5 to 9 years with and without idiopathic Ponseti-treated clubfeet were asked to complete an online questionnaire about their child's motor abilities and participation level using the Dutch version of the Assessment of Life Habits for Children (LIFE-H) version 3 to assess participation and the Dutch Movement Assessment Battery for Children-2 Checklist (MABC-2 Checklist) to assess motor abilities. Statistical analysis focused on differences between groups and the relationship between motor abilities and level of participation. RESULTS Questionnaires of 86 children with clubfeet (mean age 7.1, 73% boys) and 62 controls (age 6.7, 53% boys) were analyzed. Despite a large variation, results showed no significant differences between groups on the total scores of the LIFE-H and the MABC-2 Checklist. Children with clubfeet, however, scored lower on Mobility and better on the categories Communication and Responsibility of the LIFE-H. Furthermore, children with clubfeet showed lower scores on the MABC-2 Checklist subscale "movement in a static and/or predictable environment." High levels of the parents' perceived participation correlate with good results, as perceived by the parents, in motor ability. CONCLUSIONS Although differences on some aspects of motor ability and participation existed, children with clubfeet in general showed high levels of parents' perceived motor ability and participation. High levels of participation correlated with good results in motor ability. LEVEL OF EVIDENCE Level II.
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Pinto D, Leo DG, Aroojis A, Eastwood D, Gelfer Y. The Impact of Living with Clubfoot on Children and Their Families: Perspectives from Two Cultural Environments. Indian J Orthop 2022; 56:2193-2201. [PMID: 36507216 PMCID: PMC9705620 DOI: 10.1007/s43465-022-00748-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/06/2022] [Indexed: 02/04/2023]
Abstract
Purpose To study the physical, emotional and social impact of clubfoot on the lives of affected children and their families. Methods A purposive sample of children with treated idiopathic clubfoot and their parents was recruited from two geographical locations-the United Kingdom (UK) and India. Children were divided into age groups of 5-7 and 8-11 years. Questionnaires were administered separately to children and parents; the former comprised multiple-choice questions scored using an 'emoji' system, and the latter included open-ended questions divided into pre-defined themes of daily limitations, social life, general health, emotional barriers and family impact. Results Thirty-four children and parents participated from UK; 96 children and parents participated from India. The majority of children (> 80%) reported no problems in daily activities, although 32.8% reported having pain. Difficulty finding appropriate footwear and limitation in sports were more common among UK children, whereas difficulty in squatting was more problematic for Indian children. Self and emotional perceptions regarding their appearance/condition were lower among older as compared to younger children in both countries. Parents' responses mirrored those of children; additionally they reported emotional and financial difficulties during initial treatment phase, and ongoing concerns about the future during the maintenance phase. Conclusion Treated clubfoot continues to impact the lives of affected children and families. Perceptions of the condition and its impact vary between population groups; this needs to be appreciated when collecting and analysing outcomes.
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Affiliation(s)
- Deepika Pinto
- Department of Orthopaedics, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH UK
| | - Donato Giuseppe Leo
- St George’s Healthcare NHS Trust, London, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | | | - Yael Gelfer
- St George’s Hospital, St George’s University of London, London, UK
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Grin L, Wijnands S, Besselaar A, van Oorschot L, Vanwanseele B, van der Steen M. The relation between clinical and objective gait scores in clubfoot patients with and without a relapse. Gait Posture 2022; 97:210-215. [PMID: 35995000 DOI: 10.1016/j.gaitpost.2022.07.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/21/2022] [Accepted: 07/30/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Objective gait analysis that fully captures the multi-segmental foot movement of a clubfoot may help in early identification of a relapse clubfoot. Unfortunately, this type of objective measure is still lacking in a clinical setting and it is unknown how it relates to clinical assessment. RESEARCH QUESTION The aim of this study was to identify differences in total gait and foot deviations between clubfoot patients with and without a relapse clubfoot and to evaluate their relationship with clinical status. METHODS In this study, Ponseti-treated idiopathic clubfoot patients were included and divided into clubfoot patients with and without a relapse. Objective gait analysis was done resulting in total gait and foot scores and clinical assessment was performed using the Clubfoot Assessment Protocol (CAP). Additionally, a new clubfoot specific foot score, the clubFoot Deviation Index (cFDI*), was calculated to better capture foot kinematics of clubfoot patients. RESULTS Clubfoot patients with a relapse show lower total gait quality (GDI*) and lower clinical status defined by the CAP than clubfoot patients without a relapse. Abnormal cFDI* was found in relapse patients, reflected by differences in corresponding variable scores. Moderate relationships were found for the subdomains of the CAP and total gait and foot quality in all clubfoot patients. SIGNIFICANCE A new total foot score was introduced in this study, which was more relevant for the clubfoot population. The use of this new foot score (cFDI*) besides the GDI*, is recommended to identify gait and foot motion deviations. Along with clinical assessment, this will give an overview of the overall status of the complex, multi-segmental aspects of a (relapsed) clubfoot. The relationships found in this study suggest that clinical assessment might be indicative of a deviation in total gait and foot pattern, therefore hinting towards personalised screening for better treatment decision making.
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Affiliation(s)
- Lianne Grin
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001 Heverlee, Belgium; Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, the Netherlands.
| | - Saskia Wijnands
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001 Heverlee, Belgium; Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, the Netherlands
| | - Arnold Besselaar
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, the Netherlands
| | - Lisa van Oorschot
- Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, the Netherlands
| | - Benedicte Vanwanseele
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001 Heverlee, Belgium; Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, the Netherlands
| | - Marieke van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, the Netherlands
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Three decades of gait index development: A comparative review of clinical and research gait indices. Clin Biomech (Bristol, Avon) 2022; 96:105682. [PMID: 35640522 DOI: 10.1016/j.clinbiomech.2022.105682] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 03/14/2022] [Accepted: 05/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND A wide variety of indices have been developed to quantify gait performance markers and associate them with their respective pathologies. Indices scores have enabled better decisions regarding patient treatments and allowed for optimized monitoring of the evolution of their condition. The extensive range of human gait indices presented over the last 30 years is evaluated and summarized in this narrative literature review exploring their application in clinical and research environments. METHODS The analysis will explore historical and modern gait indices, focusing on the clinical efficacy with respect to their proposed pathology, age range, and associated parameter limits. Features, methods, and clinically acceptable errors are discussed while simultaneously assessing indices advantages and disadvantages. This review analyses all indices published between 1994 and February 2021 identified using the Medline, PubMed, ScienceDirect, CINAHL, EMBASE, and Google Scholar databases. FINDINGS A total of 30 indices were identified as noteworthy for clinical and research purposes and another 137 works were included for discussion. The indices were divided in three major groups: observational (13), instrumented (16) and hybrid (1). The instrumented indices were further sub-divided in six groups, namely kinematic- (4), spatiotemporal- (5), kinetic- (2), kinematic- and kinetic- (2), electromyographic- (1) and Inertial Measurement Unit-based indices (2). INTERPRETATION This work is one of the first reviews to summarize observational and instrumented gait indices, exploring their applicability in research and clinical contexts. The aim of this review is to assist members of these communities with the selection of the proper index for the group in analysis.
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Abstract
BACKGROUND This paper aims to report on the last 5 years of relevant research on pediatric foot and ankle pathology with specific focus on clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans. METHODS The Browzine platform was used to review the table of contents for all papers published in the following target journals related to the treatment of pediatric foot and ankle conditions. Search results were further refined to include clinical trials and randomized controlled trials published from March 1, 2015 to November 15, 2021. RESULTS A total of 73 papers were selected for review based on new findings and significant contributions in treatment of clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans. Also included were several papers that did not fit into any of these categories but provided new insight into specific foot and ankle pathologies. CONCLUSIONS Treatment strategies for children with foot and ankle pathology are continually evolving. We review many of the most recent publications with the goal of improving understanding of these pathologies and highlighting current best practices. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kali Tileston
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
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Pavone V, Sapienza M, Vescio A, Caldaci A, McCracken KL, Canavese F, Testa G. Early developmental milestones in patients with idiopathic clubfoot treated by Ponseti method. Front Pediatr 2022; 10:869401. [PMID: 36090581 PMCID: PMC9448959 DOI: 10.3389/fped.2022.869401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/02/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Idiopathic clubfoot, also referred to as congenital talipes equinovarus (CTEV), is one of the most common lower limb deformities observed in newborns, leading to significant functional impairment if untreated. The aims of this study were to (1) assess the developmental milestones in patients with CTEV treated by the Ponseti technique, and to compare them to the unaffected controls; (2) evaluate the possible correlation between developmental milestones, severity of the deformity, and number of casts. MATERIALS AND METHODS Seventy-nine subjects were divided into two groups, CTEV group (43 patients; 72 feet) and control group (36 patients). Age, sex, affected side, attainment of babbles (BAL), independent gait (IG), and combined word (CW) were recorded for all patients. In patients with CTEV, Pirani Score (PRS), number of casts (NC), and clinical outcome were collected according to the Clubfoot Assessment Protocol (CAP), The American Orthopedic Foot and Ankle Score (AOFAS), and Foot and Ankle Disability Index (FADI). RESULTS IG was achieved later later than the unaffected controls by 12/43 patients (27.9%) with CTEV and 3/36 patients in the control group (8.3%) (p = 0.04) and in a mean time of 16.8 ± 3.5 months and 13.2 ± 2.7 months, respectively (p = 0.001). In the CTEV group the mean value of CAP was 98.6 ± 4.7, of AOFAS of 98.4 ± 4.4 and of FADI equal to 99.9 ± 0.44. There were no statistically significant differences for BAL and CW; and no correlation with PRS, NC, or clinical score were identified. CONCLUSION CTEV patients managed by the Ponseti technique achieve independent gait later than the unaffected controls, although they do so within the age limit of developmental. On the other hand, the Ponseti treatment has no impact on attainment of language development.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
| | - Alessia Caldaci
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
| | - Kathryn Louise McCracken
- Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lille, France
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lille, France
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
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Grin L, van der Steen MC, Wijnands SDN, van Oorschot L, Besselaar AT, Vanwanseele B. Forefoot adduction and forefoot supination as kinematic indicators of relapse clubfoot. Gait Posture 2021; 90:415-421. [PMID: 34583148 DOI: 10.1016/j.gaitpost.2021.09.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Understanding the kinematic characteristics of relapse clubfoot compared to successfully treated clubfoot could aid early identification of a relapse and improve treatment planning. The usage of a multi segment foot model is essential in order to grasp the full complexity of the multi-planar and multi-joint deformity of the clubfoot. RESEARCH QUESTION The purpose of this study was to identify differences in foot kinematics, using a multi-segment foot model, during gait between patients with Ponseti treated clubfoot with and without a relapse and age-matched healthy controls. METHODS A cross-sectional study was carried out including 11 patients with relapse clubfoot, 11 patients with clubfoot and 15 controls. Gait analysis was performed using an extended Helen Hayes model combined with the Oxford Foot Model. Statistical analysis included statistical parametric mapping and discrete analysis of kinematic gait parameters of the pelvis, hip, knee, ankle, hindfoot and forefoot in the sagittal, frontal and transversal plane. RESULTS The relapse group showed significantly increased forefoot adduction in relation with the hindfoot and the tibia. Furthermore, this group showed increased forefoot supination in relation with the tibia during stance, whereas during swing increased forefoot supination in relation with the hindfoot was found in patients with relapse clubfoot compared with non-relapse clubfoot. SIGNIFICANCE Forefoot adduction and forefoot supination could be kinematic indicators of relapse clubfoot, which might be useful in early identification of a relapse clubfoot. Subsequently, this could aid the optimization of clinical decision making and treatment planning for children with clubfoot.
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Affiliation(s)
- L Grin
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001, Heverlee, Belgium; Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN, Eindhoven, the Netherlands.
| | - M C van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD, Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA, Eindhoven, the Netherlands
| | - S D N Wijnands
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001, Heverlee, Belgium; Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD, Eindhoven, the Netherlands
| | - L van Oorschot
- Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN, Eindhoven, the Netherlands
| | - A T Besselaar
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD, Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA, Eindhoven, the Netherlands
| | - B Vanwanseele
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001, Heverlee, Belgium; Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN, Eindhoven, the Netherlands
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Sport Ability during Walking Age in Clubfoot-Affected Children after Ponseti Method: A Case-Series Study. CHILDREN-BASEL 2021; 8:children8030181. [PMID: 33804306 PMCID: PMC8001402 DOI: 10.3390/children8030181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 01/08/2023]
Abstract
Background: The Ponseti method (PM) of manipulative treatment for congenital talipes equinovarus (CTEV) or clubfoot became widely adopted by pediatric orthopedic surgeons at the beginning of the mid-1990s with reports of long-term successful outcomes. Sports are crucial for children’s development and for learning good behavior. This study aimed to evaluate the sports activity levels in children treated with PM and to assess the different outcomes, according to gender and bilaterality. Methods: A total of 25 patients (44 feet) with CTEV treated by the PM were included in the study. The patients were clinically evaluated according to the Clubfoot Assessment Protocol, American Orthopedic Foot and Ankle Society, Ankle–Hindfoot score, the Foot and Ankle Disability Index (CAP, AOFAS, and FADI, respectively), and FADI Sport scores. Results: The overall mean CAP, AOFAS, FADI, and FADI Sport scores were 97.5 ± 6.4 (range 68.75–100), 97.5 ± 5.8 (range 73.00–100), 99.9 ± 0.6 (range 97.1–100), and 100, respectively. Gender and bilaterality did not affect outcome (p > 0.05). Conclusions: The data confirmed good-to-excellent outcomes in children with CTEV managed by PM. No limitations in sport performance or activity could be observed. In particular, male and female patients and patients with unilateral or bilateral involvement performed equally well.
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Bertinatto R, Forlin E, Wustro L, Tolotti JO, de Souza GAL. A presença do pé torto congênito atrasa o início da marcha? Rev Bras Ortop 2020; 55:637-641. [PMID: 33093730 PMCID: PMC7575361 DOI: 10.1055/s-0040-1709201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 01/20/2020] [Indexed: 10/24/2022] Open
Abstract
Resumo
Objetivo O pé torto congênito (PTC) é uma das alterações ortopédicas congênitas que mais frequentemente necessita tratamento intensivo, e pouco se sabe o impacto desse tratamento no desenvolvimento motor. O presente estudo buscou avaliar se pacientes portadores de PTC tratados pelo método de Ponseti desenvolvem a marcha mais tardiamente comparado a um grupo controle e analisar possíveis fatores relacionados.
Métodos Incluídos pacientes nascidos a termo, com < 6 meses de idade, sem tratamento prévio e com seguimento mínimo de 24 meses. O grupo controle foi de pacientes sem alterações musculoesqueléticas, atendidos no mesmo período da realização do presente estudo.
Resultados Um total de 97 pacientes formaram o grupo de estudo e 100 o grupo controle. A média de idade no início da marcha no grupo de estudo foi de 14,7 ± 3,2 meses, e 12,6 ± 1,5 meses (p < 0,05) no grupo controle. Fatores relacionados à marcha tardia foram: idade de início do tratamento > 3 semanas, número de trocas gessadas > 7, recidiva e não realização da tenotomia de Aquiles. Idade de início do tratamento > 3 semanas esteve relacionada a maior número de trocas de gessos. Gênero e lateralidade não tiveram relação com a marcha tardia.
Conclusão Pacientes com PTC tratados com o método de Ponseti apresentam marcha independente aproximadamente 2 meses mais tarde do que o grupo controle. Início mais tardio do tratamento, maior número de trocas de gessos, recidiva e não realização da tenotomia de Aquiles foram relacionados com atraso da marcha.
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Affiliation(s)
- Ronan Bertinatto
- Departamento de Ortopedia Pediátrica, Hospital Pequeno Príncipe, Curitiba, PR, Brasil
| | - Edilson Forlin
- Departamento de Ortopedia Pediátrica, Hospital Pequeno Príncipe, Curitiba, PR, Brasil
| | - Leonardo Wustro
- Departamento de Ortopedia Pediátrica, Hospital Pequeno Príncipe, Curitiba, PR, Brasil
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Normalization of Forefoot Supination After Tibialis Anterior Tendon Transfer for Dynamic Clubfoot Recurrence. J Pediatr Orthop 2020; 40:418-424. [PMID: 32205682 DOI: 10.1097/bpo.0000000000001542] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to evaluate the effect of tibialis anterior tendon transfer (TATT) on foot motion in children with clubfoot recurrence after initial Ponseti treatment. METHODS Children with dynamic clubfoot recurrence after initial Ponseti treatment who underwent TATT between 2014 and 2017 were considered for inclusion. Exclusion criteria were neurological disease, split transfer of the tendon, additional bone or joint invasive surgery, and initial treatment abroad. Of 94 children (143 TATT), 36 met the inclusion criteria. Seventeen (47%) of the 36 children with 25 clubfeet and a mean age at the time of surgery of 6.8 years participated in the study. Gait analysis, including the Oxford foot model, was conducted preoperatively and postoperatively. Furthermore, kinematic and kinetic data were compared with those of age-matched healthy children (n=18). RESULTS Forefoot supination in relation to the hindfoot and tibia was reduced during swing and at initial contact after TATT compared with preoperative values. Forefoot supination in relation to the tibia at initial contact decreased from 12.4 to 5.2 degrees after TATT (control group, 6.0 degrees). The heel showed less dynamic varus and adduction movement after TATT compared with preoperatively. Maximum ankle power was reduced preoperatively and postoperatively compared with controls. Maximum ankle dorsiflexion slightly increased after TATT. CONCLUSIONS Gait analysis showed normalization of the main components of dynamic clubfoot recurrence after TATT. This joint-sparing surgery efficiently corrects recurrent dynamic deformity. LEVEL OF EVIDENCE Level II-therapeutic.
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Gundawar CS, Desai SS, Borkar SS, Ranade A, Patel S, Oswal AV. Prospective Study of Gross Motor Milestones in Children with Severe Idiopathic Clubfoot Treated by Ponseti Method. Indian J Orthop 2020; 55:183-187. [PMID: 33569113 PMCID: PMC7851273 DOI: 10.1007/s43465-020-00214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/23/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND A prospective study of motor milestones achieved in severe clubfeet treated by Ponseti method and comparison between unilateral and bilateral clubfoot will help us gain further insight of motor milestones in these children. METHODS Prospective study of 150 consecutive children with idiopathic clubfoot who were treated by Ponseti method and in whom percutaneous tendoachilles tenotomy was performed. The gross motor milestones recorded were: rolls from back to stomach, sitting without support, standing with assistance, walks with assistance, standing alone, walking alone. This was compared with published regional and World Health Organization (WHO) normal data. RESULT 15 patients were excluded due to non-compliance and recurrence. Children with unilateral clubfoot (80 children) and bilateral clubfoot (55 children) showed a delay of 0.2-2.1 months in various milestones, and this was statistically significant when compared with both normal data. 95% children with unilateral clubfoot had independent ambulation by 17 months and in bilateral ambulation by 17.8 months. There was also a statistically significant difference in unilateral and bilateral clubfeet in all variables except sitting without support and walking with support. CONCLUSION There is a delay in achievement in all children with clubfoot, with more delay in bilateral clubfoot as compared to unilateral clubfoot. The probable reasons could be plaster treatment, possible weakness due to tendoachilles tenotomy, use of orthosis or the inherent pathology associated with clubfeet. Parents hence need to be explained about this delay.
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Affiliation(s)
| | - Sameer Shrikrishna Desai
- grid.46534.300000 0004 1793 8046KEM Hospital, Rasta Peth, Pune, India ,Pune, Maharashtra 411009 India
| | | | - Ashish Ranade
- grid.410870.a0000 0004 1805 2300Deenanath Mangeshkar Hospital, Pune, India
| | - Shyamal Patel
- grid.46534.300000 0004 1793 8046KEM Hospital, Rasta Peth, Pune, India
| | - Amrut V. Oswal
- grid.46534.300000 0004 1793 8046KEM Hospital, Rasta Peth, Pune, India
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Dillmann J, Schwarzer G, Peterlein CD. Motor and cognitive functioning in children treated for idiopathic clubfoot at the age of 3 years. BMC Pediatr 2019; 19:394. [PMID: 31664958 PMCID: PMC6821002 DOI: 10.1186/s12887-019-1765-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 10/09/2019] [Indexed: 12/12/2022] Open
Abstract
Background Several studies have investigated motor and cognitive skills in infants as well as gross motor abilities in schoolchildren treated for congenital idiopathic clubfoot, mostly indicating specific impairments in those children. However, until now, little is known about the motor and cognitive abilities of preschool children treated for idiopathic clubfoot. Thus, it was the aim of this study to examine gross motor, fine motor and cognitive skills of 3-year-old-children treated for idiopathic clubfoot. Method We tested gross motor, fine motor and cognitive functioning of 10 children treated for idiopathic clubfoot and 10 typically developing children at the age of 40 months (SD = 1) with the Bayley Scales of Infant and Toddler Development. Results The children treated for idiopathic clubfoot showed a slight delay in gross motor development. In particular, they demonstrated difficulties in tiptoeing, walking upstairs and walking downstairs. Moreover, we found some slight deficits in cognitive development, particularly in visual-spatial memory. Discussion Children treated for idiopathic clubfoot appear to have an increased risk of gross motor and spatial cognitive deficits. Orthopedic pediatrics should incorporate measures of gross motor functioning, for example tiptoeing, in their orthopedic setting. Moreover, future studies are needed to clarify whether the observed deficits persist through childhood. If so, some kind of a motor training for children with idiopathic clubfoot might be required.
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Affiliation(s)
- Julia Dillmann
- Department of Developmental Psychology, Justus-Liebig-University, Otto-Behaghel-Str. 10F, 35394, Gießen, Germany.
| | - Gudrun Schwarzer
- Department of Developmental Psychology, Justus-Liebig-University, Otto-Behaghel-Str. 10F, 35394, Gießen, Germany
| | - Christian-Dominik Peterlein
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstraße, 35043, Marburg, Germany
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Abstract
PURPOSE The signs for clubfoot relapse are poorly defined in the literature and there is a lack of a scoring system that allows assessment of clubfeet in ambulatory children. The aim of this study is to develop an easy to use, reliable and validated evaluation tool for ambulatory children with a history of clubfoot. METHODS A total of 52 feet (26 children, 41 clubfeet, 11 unaffected feet) were assessed. Three surgeons used the seven-item PBS Score to rate hindfoot varus, standing and walking supination, early heel rise, active/passive ankle dorsiflexion and subtalar abduction blinded to the other examiners. All parents answered the modified Roye score questionnaire prior to the clinical assessment. Correlation between the mean PBS Score and the Roye score was evaluated using Spearman's rank correlation coefficient. Interobserver reliability was tested using weighted and unweighted Cohen's Kappa coefficients. RESULTS The Spearman's rank correlation coefficient for correlation between mean PBS Score and Roye score was 0.73 (moderate to good correlation).The interobserver agreement for the total PBS Score resulted in an intraclass correlation coefficient of 0.93 (almost perfect agreement). CONCLUSION The PBS score is an easy to use, clinical assessment tool for walking age children with clubfoot deformity. It includes passive and active criteria with a very good interobserver reliability and moderate to good validity. LEVEL OF EVIDENCE Level I - Diagnostic study.
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Affiliation(s)
- S. Böhm
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Correspondence should be sent to Stephanie Böhm, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden. E-mail:
| | - M. F. Sinclair
- King’s College Hospital London in Dubai, Dubai, United Arab Emirates,Marc Sinclair, King’s College Hospital London in Dubai, UAE – Orthopaedics Dubai, United Arab Emirates.
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Manousaki E, Esbjörnsson AC, Mattsson L, Andriesse H. Correlations between the Gait Profile Score and standard clinical outcome measures in children with idiopathic clubfoot. Gait Posture 2019; 71:50-55. [PMID: 31005855 DOI: 10.1016/j.gaitpost.2019.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 03/09/2019] [Accepted: 04/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Measures of overall gait deviations such as the Gait Profile Score (GPS) and the Gait Variable Score (GVS) are used to evaluate gait in clinical practice and for research purposes. In the clinical setting, gait deviations are often visually assessed and classified using structured protocols such as the Clubfoot Assessment Protocol (CAP). RESEARCH QUESTION Determine the relationship between measures of overall gait deviations and clinical assessments. METHODS This cross-sectional study evaluated the usability of GPS and GVS in children with idiopathic clubfoot. Twenty consecutively born children with idiopathic clubfoot participated in this study. At 7 years of age, the children were referred for three-dimensional gait analysis and, on the same day, they also underwent a clinical examination according to the CAP. RESULTS The overall gait deviations, expressed as the GPS (overall and affected side) and the GVS for nine key variables were calculated. The correlations between the GPS and values from CAP, its domains, and a single item called walking and between the item walking and the GVS values were analyzed using the Spearman's rank correlation coefficient (rs). The item walking correlated significantly with the GPS (rs = -0.62), and the GVS for foot progression (rs = -0.61) and foot dorsiflexion/plantarflexion (rs = -0.50). The domain "morphology" correlated with the GPS (rs = 0.64). SIGNIFICANCE These findings indicate that the GPS index along with the GVS reflects gait deviations observed clinically in children with clubfoot.
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Affiliation(s)
- Evgenia Manousaki
- Lund University, Department of Clinical Sciences, Orthopedics, SE 221 85, Lund, Sweden.
| | | | | | - Hanneke Andriesse
- Lund University, Department of Clinical Sciences, Orthopedics, SE 221 85, Lund, Sweden.
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Abstract
PURPOSE Treatment of idiopathic clubfoot (IC) has improved since the introduction of the Ponseti method. However, relapses are still common and primarily related to non-adherence to the brace regime. Our hypothesis was that IC might be more than just a structural deformity. Based on three studies, the aim of this paper was to provide an overview of findings regarding additional challenges within IC. METHODS In total, 153 children with IC and 137 control children participated in the studies. The first study assessed gross motor skills in six motor tasks using the Clubfoot Assessment Protocol. The second and third studies surveyed neurodevelopmental difficulties (NDDs) using the Five to Fifteen (FTF) questionnaire and health-related quality of life (HRQoL) using the EuroQol-5D youth. RESULTS A high percentage of gross motor deviations were found in children with IC compared with controls, and those correlated poorly with clubfoot severity and foot movement. Children with IC had a higher prevalence of NDDs on the FTF compared with the control group, including the domains: motor skills, perception and language. One-third of children with IC were defined as at risk of developmental disorders. In this subgroup, parents were less satisfied with the outcome of clubfoot treatment and the children reported worse HRQoL than those without NDDs. CONCLUSION The findings suggest additional challenges in children with IC, such as NDDs, apparently affecting both clubfoot treatment outcome and HRQoL. Thus, awareness of these challenges could be vital to further optimize treatment and support, for example, with regards to brace adherence. LEVEL OF EVIDENCE II - Prognostic study.
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Affiliation(s)
- E. Lööf
- Paediatric Neurology, Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden,Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden,Correspondence should be sent to Elin Lööf, Paediatric Neurology QB:27, Department of Women’s and Children’s Health, Karolinska Institutet, 171 76 Stockholm, Sweden. E-mail:
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Lööf E, Andriesse H, Broström EW, André M, Bölte S. Neurodevelopmental difficulties in children with idiopathic clubfoot. Dev Med Child Neurol 2019; 61:98-104. [PMID: 30132825 DOI: 10.1111/dmcn.13996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2018] [Indexed: 12/13/2022]
Abstract
AIM To evaluate neurodevelopmental difficulties in children with idiopathic clubfoot. METHOD A cross-sectional study of 106 children (29 females, 77 males; aged 8-10y) with idiopathic clubfoot and 109 age-, sex-, and residential area-parallelized children from the general population. Neurodevelopmental difficulties were assessed using the parent-report Five to Fifteen (FTF) questionnaire. Group differences were analysed for FTF domains, subdomains, and items. The 90th centile cut-off of the general population on FTF and the parent-based disease-specific instrument (DSI) were used to evaluate clinical relevance of neurodevelopmental symptoms in idiopathic clubfoot. RESULTS Modest group differences were found for several FTF domains (motor skills, perception, and language) and subdomains (gross and fine motor skills, relation in space, comprehensive and expressive language skills). Thirty-one per cent of the children with idiopathic clubfoot scored in the clinically significant range on 2 or more FTF domains. DSI scores were lower in this subgroup. INTERPRETATION Findings indicate a moderate and selective increase of neurodevelopmental difficulties in children with idiopathic clubfoot as a whole, especially in the areas of motor skills, perception, and language. Idiopathic clubfoot with marked neurodevelopmental symptoms are associated with less satisfaction of the clubfoot treatment. Our results recommend awareness of neurodevelopmental difficulties in the assessment and treatment of idiopathic clubfoot. WHAT THIS PAPER ADDS A substantial minority of children with idiopathic clubfoot show neurodevelopmental difficulties. Children with idiopathic clubfoot might present additional difficulties in motor skills, perception, and language. Children with idiopathic clubfoot and marked neurodevelopmental symptoms show poorer parent-reported clubfoot treatment satisfaction. Neurodevelopmental difficulties should be considered in clinical practice of idiopathic clubfoot.
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Affiliation(s)
- Elin Lööf
- Division of Neurology/Orthopedics/Reumatology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | | | - Eva W Broström
- Division of Neurology/Orthopedics/Reumatology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Pediatric Neurology and Musculoskeletal Disorders and Home Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Marie André
- Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Division of Neuropsychiatry, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
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Tuinsma ABM, Vanwanseele B, van Oorschot L, Kars HJJ, Grin L, Reijman M, Besselaar AT, van der Steen MC. Gait kinetics in children with clubfeet treated surgically or with the Ponseti method: A meta-analysis. Gait Posture 2018; 66:94-100. [PMID: 30170140 DOI: 10.1016/j.gaitpost.2018.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/26/2018] [Accepted: 08/09/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Currently, the Ponseti method is the gold standard for treatment of clubfeet. For long-term functional evaluation of this method, gait analysis can be performed. Previous studies have assessed gait differences between Ponseti treated clubfeet and healthy controls. RESEARCH QUESTION/PURPOSE The aims of this systematic review were to compare the gait kinetics of Ponseti treated clubfeet with healthy controls and to compare the gait kinetics between clubfoot patients treated with the Ponseti method or surgically. METHODS A systematic search was performed in Embase, Medline Ovid, Web of Science, Scopus, Cochrane, Cinahl ebsco, and Google scholar, for studies reporting on gait kinetics in children with clubfeet treated with the Ponseti method. Studies were excluded if they only used EMG or pedobarography. Data were extracted and a risk of bias was assessed. Meta-analyses and qualitative analyses were performed. RESULTS Nine studies were included, of which five were included in the meta-analyses. The meta-analyses showed that ankle plantarflexor moment (95% CI -0.25 to -0.19) and ankle power (95% CI -0.89 to -0.60, were significantly lower in the Ponseti treated clubfeet compared to the healthy controls. No significant difference was found in ankle dorsiflexor and plantarflexor moment, and ankle power between clubfeet treated with surgery compared to the Ponseti method. SIGNIFICANCE Differences in gait kinetics are present when comparing Ponseti treated clubfeet with healthy controls. However, there is no significant difference between surgically and Ponseti treated clubfeet. These results give more insight in the possibilities of improving the gait pattern of patients treated for clubfeet.
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Affiliation(s)
- A B M Tuinsma
- Department of Orthopaedic Surgery, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA, Eindhoven, The Netherlands
| | - B Vanwanseele
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Ds Theodor Fliednerstraat 2, 5361 BN, Eindhoven, The Netherlands; Department of Kinesiology, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - L van Oorschot
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Ds Theodor Fliednerstraat 2, 5361 BN, Eindhoven, The Netherlands
| | - H J J Kars
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Ds Theodor Fliednerstraat 2, 5361 BN, Eindhoven, The Netherlands
| | - L Grin
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Ds Theodor Fliednerstraat 2, 5361 BN, Eindhoven, The Netherlands
| | - M Reijman
- Orthopaedic Center Máxima, Máxima Medical Center, Postbus 90052, 5600 PD, Eindhoven, The Netherlands; Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - A T Besselaar
- Department of Orthopaedic Surgery, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA, Eindhoven, The Netherlands; Orthopaedic Center Máxima, Máxima Medical Center, Postbus 90052, 5600 PD, Eindhoven, The Netherlands
| | - M C van der Steen
- Department of Orthopaedic Surgery, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA, Eindhoven, The Netherlands.
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Aulie VS, Halvorsen VB, Brox JI. Motor abilities in 182 children treated for idiopathic clubfoot: a comparison between the traditional and the Ponseti method and controls. J Child Orthop 2018; 12:383-389. [PMID: 30154930 PMCID: PMC6090191 DOI: 10.1302/1863-2548.12.170195] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of the study was to examine motor abilities in children treated for idiopathic clubfoot with either the traditional extensive surgery method or the Ponseti method, and compare their motor skills with a control group without clubfoot. METHODS A total of 89 children treated according to the traditional method (mean age 9.0 years, 7 to 10) and 93 treated ad modum Ponseti (mean age 8.8 years, 7 to 10) were recruited from a multicentre clinical study in Norway. A total of 45 age-matched children without clubfoot were recruited from a nearby school. They were all assessed with the Movement Assessment Battery for Children - Second Edition (MABC-2), which evaluates motor performance. We applied Analysis of Covariance for comparison of the two treatment methods and adjusted for gender, laterality, comorbidity, achillotomy or more extended surgery, physiotherapy and the age when the child walked independently. RESULTS We found no significant difference in any of the various components or the total score of the MABC-2 between patients treated with the two different methods. In all, 76% of the children treated according to the traditional method and ad modum Ponseti, and 96% in the control group, respectively, were classified as having normal motor abilities. CONCLUSION About three-quarters of children aged nine years and treated for idiopathic clubfoot had normal motor abilities. We found similar results in patients treated with the traditional method and the Ponseti method. LEVEL OF EVIDENCE II.
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Affiliation(s)
- V. S. Aulie
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Box 4956 Nydalen, 0424 Oslo, Norway, Correspondence should be sent to V. S. Aulie, Oslo University Hospital, Box 4956 Nydalen, 0424 Oslo, Norway.
| | - V. B. Halvorsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Box 4956 Nydalen, 0424 Oslo, Norway
| | - J. I. Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Box 4956 Nydalen, 0424 Oslo, Norway,Medical Faculty, University of Oslo, 0316 Oslo, Norway
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