The significance of foot length at the initiation of the Ponseti method: A prospective study

Abstract

Objectives We sought to evaluate foot length (FL) and forefoot circumference (FC) and their impact on the severity of idiopathic clubfoot (CF) and results of treatment. We hypothesized that a smaller foot size at birth that represents a lesser than term newborn may affect the response of the CF to the treatment. Methods We conducted a prospective study documenting FL and FC of all neonates presented with idiopathic CF. Additional demographic information was collected. Outcome measures were number of casts needed for correction, need for recasting, additional surgery and functional score. Results In all, 52 children with 73 CF with a minimum mean follow-up of two years (2.0 to 5.6; sd 1.08) were evaluated. Mean gestational age was 38.63 weeks and mean birth weight (BW) was 3184 g. The mean FL at presentation was 74 mm (5.70 to 9.00), initial Pirani score was 5.5 (2.5 to 6.0) while number of casts was 6.9 (4.0 to 11.0). The FL was significantly correlated both to initial Pirani score (r = -0.35; p < 0.01) and number of casts (r = -0.33; p < 0.05). Positive correlation was found between the number of casts to Pirani score and number of additional procedures (r = 0.39; r = 0.36; p < 0.01, respectively). A foot size of up to 8 cm, needed 7.3 casts (4 to 7) compared with a FL of 8 cm or longer who needed 4.7 casts (4 to 6; t = 7.11; p < 0.001). Conclusion FL is a simple approach to identify preterm babies. It can be used as part of the initial evaluation of CF and help in predicting the course of treatment. We recommend adding FL to the existing classification. Level of Evidence I - Prognostic study

Development of Foot Length in Children with Congenital Clubfoot up to 7 Years of Age: A Prospective Follow-Up Study

“…Small clubfeet have been associated with di culties at initial correction and increased risk of relapse [4,6,7]. We found that a greater difference in foot length at baseline in children with unilateral clubfeet was related to an increased number of relapses and worse motion quality score at the age of 7.…”

“…In our clinical settings, we have observed irregular foot growth in relapsed clubfeet and poorer motion quality in children with smaller clubfeet compared with children with larger clubfeet. Foot size at birth can affect treatment results as it is sometimes more di cult to correct the initial deformity in smaller feet [4][5][6][7]. Hemo et al found that severity score at baseline and number of casts needed for correction correlated with foot length before the start of treatment [7].…”

“…Foot size at birth can affect treatment results as it is sometimes more di cult to correct the initial deformity in smaller feet [4][5][6][7]. Hemo et al found that severity score at baseline and number of casts needed for correction correlated with foot length before the start of treatment [7]. Foot size at end of growth can also depend on the treatment method [8][9][10].…”

Development of foot length in children with congenital clubfoot up to 7 years of age: a prospective follow-up study

“…In our clinical settings, we have observed irregular foot growth in relapsed clubfeet and poorer motion quality in children with smaller clubfeet compared with children with larger clubfeet. Foot size at birth can affect treatment results as it is sometimes more difficult to correct the initial deformity in smaller feet [ 4 – 7 ]. Hemo et al found that severity score at baseline and number of casts needed for correction correlated with foot length before the start of treatment [ 7 ].…”

Special symposium issue: Clubfoot

“…Before starting treatment, the foot length might be one aspect to take into consideration as discussed in Hemo et al’s paper on ‘The significance of foot length at the initiation of the Ponseti method: a prospective study’. 2…”