Surgical Versus Ponseti Approach for the Management of CTEV

Duffy, Catherine; Salazar, J; Humphreys, L.; McDowell, B.C.

doi:10.1097/bpo.0b013e31827d0b2c

Cited by 41 publications

(59 citation statements)

References 46 publications

(59 reference statements)

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“…In a systematic review of orthopaedic literature, Bryant et al [2] found that 42% of clinical studies in high-impact-factor orthopaedic journals had inappropriately used multiple observations from single individuals. In clubfoot research, Duffy et al [7] combined multiple data from single individuals noting that an earlier study had observed no difference in findings when excluding data of one foot in bilateral clubfeet cases; however, this study had used statistical methods that assumed that each data point was independent [16]. In a trial comparing the French functional technique and Ponseti technique, Richards et al [16] reported that the feet of patients with bilateral clubfeet were almost identical.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Clubfeet Are Highly Correlated: A Cautionary Tale for Researchers

Gray

Gibbons

Little

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Congenital talipes equinovarus, or clubfoot, is a common pediatric orthopaedic condition of unknown origin. In many clubfoot clinical trials, interventions are assigned to a patient, but response to treatment is assessed separately in each foot. Trials commonly report x patients with y feet where y is greater than x (eg, 35 patients with 56 feet). However, common statistical tests assume that each data point is independent. Although data from unilateral cases of clubfoot are independent, it is unknown if each foot of patients with bilateral clubfeet are correlated. Questions/purposes The purpose of this study was to assess the correlation in the feet of patients with bilateral clubfeet by (1) evaluating the degree of severity between lower limbs of each patient with bilateral clubfeet at baseline; (2) determining if right and left feet of each patient responded to intervention in the same way; (3) determining the proportion of bilateral relapse; and (4) determining the proportion of right and left feet which required the same intervention to correct bilateral relapse. Methods We performed a chart review of the records of 33 patients with bilateral clubfeet (66 feet). Baseline severity was assessed using the Pirani score. The number of Ponseti serial casts to correct the deformity, the proportion of patients who underwent bilateral Achilles tenotomy, the proportion of bilateral relapse, and the treatment to correct bilateral relapse were examined. Results The degree of severity between right (Pirani score mean, 5.2; SD, 0.8) and left (Pirani score mean, 5.2; SD, 0.5) feet for each patient at baseline was highly correlated (r = 0.76, p \ 0.001). Response to intervention between lower limbs was highly correlated for the number of Ponseti casts required for initial correction (right mean, 5.2, SD, 1.1; left mean, 5.2, SD, 1.3) (r = 0.89, p \ 0.001) and the proportion of patients who underwent bilateral Achilles tenotomy (right, 17/18; left, 16/18) (r = 0.94, p \ 0.001). In the nine patients who experienced relapse, eight experienced bilateral involvement. In all cases of bilateral relapse, the right and left foot of each patient required the same intervention to correct the relapse. Conclusions In patients with bilateral clubfeet, baseline severity, response to initial Ponseti treatment, Achilles tenotomy, and relapse outcomes were highly correlated in

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Section: Discussionmentioning

confidence: 99%

Bilateral Clubfeet Are Highly Correlated: A Cautionary Tale for Researchers

Gray

Gibbons

Little

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…The PFF group in this study had worse child-reported OxAFQ-C scores in all domains compared to the Ponsetti group and in all but the emotional domain compared to the surgically managed group. Kennedy et al [28] assessed HRQOL related to foot and ankle abnormalities in Hurler’s Syndrome. They reported an average OxAFQ-C score of 44.7 out of 60; however, as an overall combined score has not been validated for this questionnaire, a direct comparison with the children in this study cannot be made.…”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life in children with flexible flatfeet: A cross-sectional study

Kothari

Stebbins

Zavatsky

et al. 2014

Journal of Children's Orthopaedics

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PurposeThe effect of paediatric flexible flatfeet (PFF) on health-related quality of life (HRQOL) has not been investigated. In this prospective cross-sectional study, the HRQOL of children with PFF was compared to those with typically developing feet (TDF) using two validated measures. We hypothesised that reduced HRQOL would be observed in children with PFF. The reliability of parents’ perceptions of their child’s symptoms was also investigated.Methods48 children with PFF and 47 with TDF between the ages of 8 and 15 completed The Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) and Pediatric Quality of Life Inventory (PedsQL™ 4.0). Proxy questionnaires were also completed. Reliability of parent and child questionnaire scores was assessed using the intraclass correlation coefficient (ICC) and Student’s t test. Differences between HRQOL between PFF and TDF were assessed using the Student’s t test.ResultsICCs overall demonstrated good reliability between parent and child questionnaire domain scores. There was a tendency for parents to overestimate the impairment of the child in the PFF group. PFF children demonstrated clinically significant decreased HRQOL than TDF children. This was most marked in the physical domain scores.ConclusionAlthough parents may overestimate their child’s impairment, children with PFF still have significantly impaired HRQOL when compared to TDF children. The impairment can be as severe, or worse, than published HRQOL for acutely and chronically unwell children. As such, PFF cannot be regarded as just a benign normal variant. The management of PFF should involve consideration of the symptom profile and HRQOL.Level of evidence:II.Electronic supplementary materialThe online version of this article (doi:10.1007/s11832-014-0621-0) contains supplementary material, which is available to authorized users.

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“…Gait analysis following clubfoot treatment has primarily been used in studies involving operatively treated patients [6][7][8][9][10][11][12][13][14][15][16][17][18] ; few have evaluated the Ponseti method in this fashion [19][20][21][22][23][24] . Special foot models allow more detailed evaluation of the foot and of treatment outcomes 11,15,[23][24][25] .…”

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confidence: 99%