Clubfoot Activity and Recurrence Exercise Study (CARES)

Abstract

Background: Approximately half of treated clubfoot patients initially corrected with the Ponseti method experience relapse that requires additional treatment. The consequences of relapse on childhood activity levels have not been well studied. Ponseti noted lower functional ratings at 18-year follow-up in clubfoot patients who had undergone tibialis anterior tendon transfer for relapse. Methods: Clubfoot Activity and Recurrence Exercise study (CARES) is an observational, prospective cohort study that compares physical activity in 30 clubfoot patients without and with relapse. Eligible participants were 5 to 10 years old, diagnosed with idiopathic clubfoot at birth, and had not received any clubfoot treatment for at least 6 months before study. Recruitment for this study occurred in-person and through Facebook clubfoot groups. Consented participants wore Fitbits secured to their wrists for at least 14 days, and completed a demographic survey, Child Health Questionnaire (CHQ), and the clubfoot disease-specific instrument (CDSI). Participants' daily activity was monitored through Fitabase. Results: Participants without and with clubfoot relapse had similar daily step counts, distance walked, and step intensities, except for moderately active step intensity, which was higher in the clubfoot relapse group. Total steps, total distance, distances (very active, moderately active), minutes (very active, fairly active), and lightly active intensity of steps were significantly higher for participants whose families earn more than $100,000 per year. Various physical activities and sports were reported by both groups in daily activity sheets. Neither demographics nor the CDSI or the CHQ scores significantly differed between the 2 groups.Step counts of children with clubfoot with or without relapse were similar to published levels for healthy children. Conclusion:Children with clubfoot initially treated with the Ponseti method who undergo treatment for relapse have comparable physical activity to those who have not relapsed. They also have comparable step counts to that of the general pediatric population. These reassuring findings can guide conversations with parents when addressing concerns regarding their children's physical activity after treatment for relapse of clubfoot deformity.Level of Evidence: Level II-therapeutic studies-investigating the results of treatment.

What’s New in Pediatric Orthopaedics

“…A prospective, observational cohort study evaluated physical activity in patients who had clubfoot, were <10 years of age, and did or did not have relapse and found no difference in daily step counts, step intensity, or distance walked. Step counts in all patients with clubfoot were similar to general population metrics 53 .…”

What is New in Pediatric Orthopaedic Foot and Ankle

“…Aulie et al3 found that 96% of school aged children treated for idiopathic clubfoot with the Ponseti method have normal function when compared with age-matched controls in the same population. Several other studies similarly demonstrated comparable activity levels and have similar patient reported outcome scores when compared with the general pediatric population 4–6. For patients diagnosed in utero, Mahan et al7 found that prenatal counseling of families by an orthopaedic surgeon did not decrease parental anxiety; however, anxiety decreased as treatment progressed.…”

“…Several other studies similarly demonstrated comparable activity levels and have similar patient reported outcome scores when compared with the general pediatric population. [4][5][6] For patients diagnosed in utero, Mahan et al 7 found that prenatal counseling of families by an orthopaedic surgeon did not decrease parental anxiety; however, anxiety decreased as treatment progressed.…”

Participation and Motor Abilities in Children Aged 5 to 9 Years With Idiopathic Clubfeet After Treatment With the Ponseti Method

“…Relapse patients show multiple structural impairments which contribute to gait issues at the ankle and knee 24,25. Recent studies show lower clinical status in relapse patients compared with nonrelapse patients,26 but after relapse treatment, comparable physical activity was found 27. In the current clubfoot group, 34% of the parents reported additional surgical interventions.…”

“…24,25 Recent studies show lower clinical status in relapse patients compared with nonrelapse patients, 26 but after relapse treatment, comparable physical activity was found. 27 In the current clubfoot group, 34% of the parents reported additional surgical interventions. However, because of the diversity of terminology used to describe interventions, we decided not to use this information to further analyze the data in respect to possible relapse.…”