Foot function during gait and parental perceived outcome in older children with symptomatic club foot deformity

Abstract

Aims To assess if older symptomatic children with club foot deformity differ in perceived disability and foot function during gait, depending on initial treatment with Ponseti or surgery, compared to a control group. Second aim was to investigate correlations between foot function during gait and perceived disability in this population. Methods In all, 73 children with idiopathic club foot were included: 31 children treated with the Ponseti method (mean age 8.3 years; 24 male; 20 bilaterally affected, 13 left and 18 right sides analyzed), and 42 treated with primary surgical correction (mean age 11.6 years; 28 male; 23 bilaterally affected, 18 left and 24 right sides analyzed). Foot function data was collected during walking gait and included Oxford Foot Model kinematics (Foot Profile Score and the range of movement and average position of each part of the foot) and plantar pressure (peak pressure in five areas of the foot). Oxford Ankle Foot Questionnaire, Disease Specific Index for club foot, Paediatric Quality of Life Inventory 4.0 were also collected. The gait data were compared between the two club foot groups and compared to control data. The gait data were also correlated with the data extracted from the questionnaires. Results Our findings suggest that symptomatic children with club foot deformity present with similar degrees of gait deviations and perceived disability regardless of whether they had previously been treated with the Ponseti Method or surgery. The presence of sagittal and coronal plane hindfoot deformity and coronal plane forefoot deformity were associated with higher levels of perceived disability, regardless of their initial treatment. Conclusion This is the first paper to compare outcomes between Ponseti and surgery in a symptomatic older club foot population seeking further treatment. It is also the first paper to correlate foot function during gait and perceived disability to establish a link between deformity and subjective outcomes Cite this article: Bone Joint Open 2020;1-7:384–391.

The Predictive Value of Radiographs and the Pirani Score for Later Additional Surgery in Ponseti-Treated Idiopathic Clubfeet, an Observational Cohort Study

“…Parent satisfaction was very high (93 (IQR 79–97)) when we compared them to satisfaction rates other authors found (65–83%) [ 27 , 28 , 29 ]. Parents whose children needed additional surgery had a lower satisfaction score.…”

“…When we observe our data, a ceiling effect might have occurred, i.e., the instrument was not able to discriminate differences in mildly impaired individuals [ 28 ]. The DSI was developed in 2001 in a surgically treated cohort of clubfoot patients, which are known to have a lower satisfaction rate, while the current cohort was treated with Ponseti casting, and all surgeries were performed extra-articular [ 18 , 28 , 29 ].…”

What is the optimal treatment for equinus deformity in walking-age children with clubfoot? A systematic review

“… 20 In a study assessing correlations between foot function and perceived disability, McCahill et al found that perceived disability was associated with equinus deformity, hindfoot deformity in coronal and sagittal planes, and medial forefoot pressure gait parameters. 21 Residual or recurrent deformity of the hindfoot causes significant disability. It is challenging to correct and also to maintain the correction.…”

Radiological tarsal bone morphology in adolescent age of congenital clubfeet treated with the Ponseti method

“…Additionally, it is unknown whether severe tarsal bone deformities, often observed after primary surgical therapy of clubfeet, occur or persist after the Ponseti treatment [ 11 – 14 ]. Clinical experience with residual clubfoot deformities in adult patients shows that in many cases the condition of the ankle will determine the long-term clinical outcome [ 15 – 17 ]. In this context, supramalleolar valgus misgrowth and dysplasia of the talus with a significantly reduced or flattened articular surface of the trochlea tali (“flat top talus”) have often been observed after initial surgical treatment of clubfeet and were associated with poor clinical outcome [ 12 , 14 , 18 ].…”