Kinematic Gait Impairments in Children with Clubfeet Treated by the Ponseti Method: A Systematic Review and Meta-Analysis

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.

Seguimiento de los pacientes con pie Bot durante la pandemia del SARS CoV-2: frecuencia y causas del abandono del tratamiento

“…Los pacientes del presente estudio por el promedio de edad que tenían abandonaron el tratamiento muy precozmente. Esta situación se asocia a una mayor dificultad en el manejo futuro, mayores posibilidades del tratamiento quirúrgico y secuelas como los trastornos en la marcha, rigidez (15)(16)(17) del pie entre otros .…”

Three-dimensional gait analysis of orthopaedic common foot and ankle joint diseases

“…The purpose of treating clubfoot is to relieve foot pain, obtain a normal appearance, and restore normal function. At present, the Ponseti method (manipulation, casting, cementing, or an Achilles tenotomy) is considered the gold standard for early treatment ( Ganesan et al, 2017 ; Grin et al, 2023 ). A transplantar pressure study showed that, compared to those of the healthy side and control group, clubfoot treated with the Ponseti method had higher peak pressure (PP) and pressure‒time integral (PTI) in the lateral forefoot and midfoot; moreover, the contact area reported as a percentage of the total foot area (CA%) was also significantly greater, while the PP and PTI were significantly lower in the medial forefoot and hindfoot, suggesting that the affected foot experiences significantly greater mechanical stress during walking and that the load is transferred from the medial side of the foot to the lateral forefoot and midfoot ( Xu et al, 2018 ).…”