1
|
Wijnands SDN, Grin L, van Dijk LS, Besselaar AT, van der Steen MC, Vanwanseele B. Clubfoot patients show more anterior-posterior displacement during one-leg-standing and less ankle power and plantarflexor moment during one-leg-hopping than typically developing children. Gait Posture 2024; 108:361-366. [PMID: 38227996 DOI: 10.1016/j.gaitpost.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND Clubfoot patients show good-to-excellent foot correction after the Ponseti method. Nevertheless, underlying functional problems that limit motor abilities such as one-leg-standing and one-leg-hopping still persist. These restrictions have been proposed to arise due to problems with maintaining balance and the limited force-generating capacity of clubfoot patients. More insight is needed to understand the underlying limiting factors to improve overall motor ability in clubfoot patients. RESEARCH QUESTION The aim of this study was to determine the differences between clubfoot patients and typically developing children (TDC) in force and balance parameters during walking, one-leg-standing and hopping. METHODS Three-dimensional motion analysis was performed in 19 TDC and 16 idiopathic Ponseti-treated clubfoot patients between 5-9 years old. Kinematic and kinetic parameters were calculated during walking and one-leg-hopping. To describe the balance parameters, center of pressure (CoP) data was assessed during walking, one-leg-hopping and one-leg-standing. Mean group values were calculated and compared using nonparametric statistical tests. A general linear model with repeated measures was used to determine which activity showed the largest group differences. RESULTS Clubfoot patients showed lower peak plantarflexor moment and peak ankle power absorption and generation during one-leg-hopping compared to TDC. Furthermore, clubfoot patients showed a lower hop length and velocity than TDC. The difference in peak plantarflexor moment and ankle power between the study groups was larger during one-leg-hopping than during walking. Finally, clubfoot patients showed a higher anterior-posterior CoP range during one-leg-standing. SIGNIFICANCE Deviations in force parameters seemed to limit one-leg-hopping in clubfoot patients, and impaired anterior-posterior static balance was thought to be the underlying cause of problems with one-leg-standing. Furthermore, one-leg-hopping was more sensitive to distinguish between clubfoot patients and TDC than walking. Individualized physiotherapy targeting static balance and force parameters, with extra emphasis on including eccentric contractions, might improve the overall motor abilities of clubfoot patients.
Collapse
Affiliation(s)
- S D N Wijnands
- Human Movement Biomechanics Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Postbus 550, 3000 Leuven, Belgium; Department of Orthopaedic Surgery & Trauma, Máxima MC, Postbus 90052, 5600 PD Eindhoven, the Netherlands
| | - L Grin
- Human Movement Biomechanics Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Postbus 550, 3000 Leuven, Belgium; Fontys University of Applied Sciences, Postbus 347, 5612 MA Eindhoven, the Netherlands.
| | - L S van Dijk
- Fontys University of Applied Sciences, Postbus 347, 5612 MA Eindhoven, the Netherlands
| | - A T Besselaar
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Postbus 90052, 5600 PD Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, the Netherlands
| | - M C van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Postbus 90052, 5600 PD Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, the Netherlands
| | - B Vanwanseele
- Human Movement Biomechanics Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Postbus 550, 3000 Leuven, Belgium; Fontys University of Applied Sciences, Postbus 347, 5612 MA Eindhoven, the Netherlands
| |
Collapse
|
2
|
Participation and Motor Abilities in Children Aged 5 to 9 Years With Idiopathic Clubfeet After Treatment With the Ponseti Method. J Pediatr Orthop 2023; 43:e36-e42. [PMID: 36253894 DOI: 10.1097/bpo.0000000000002278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Functioning in children consists of different aspects, including their ability to execute activities and participate in life situations. Several studies on children with clubfeet showed limited motor abilities and walking capacity compared with healthy control children, while other studies showed comparable athletic abilities and gross motor development. Although participation in activities of daily life plays an important role in the development of children, this has not yet been investigated in children with clubfeet. The study aims to determine the level of parents' perceived motor ability and participation in Ponseti-treated children with clubfeet compared with age-matched healthy controls. METHODS Parents of children aged 5 to 9 years with and without idiopathic Ponseti-treated clubfeet were asked to complete an online questionnaire about their child's motor abilities and participation level using the Dutch version of the Assessment of Life Habits for Children (LIFE-H) version 3 to assess participation and the Dutch Movement Assessment Battery for Children-2 Checklist (MABC-2 Checklist) to assess motor abilities. Statistical analysis focused on differences between groups and the relationship between motor abilities and level of participation. RESULTS Questionnaires of 86 children with clubfeet (mean age 7.1, 73% boys) and 62 controls (age 6.7, 53% boys) were analyzed. Despite a large variation, results showed no significant differences between groups on the total scores of the LIFE-H and the MABC-2 Checklist. Children with clubfeet, however, scored lower on Mobility and better on the categories Communication and Responsibility of the LIFE-H. Furthermore, children with clubfeet showed lower scores on the MABC-2 Checklist subscale "movement in a static and/or predictable environment." High levels of the parents' perceived participation correlate with good results, as perceived by the parents, in motor ability. CONCLUSIONS Although differences on some aspects of motor ability and participation existed, children with clubfeet in general showed high levels of parents' perceived motor ability and participation. High levels of participation correlated with good results in motor ability. LEVEL OF EVIDENCE Level II.
Collapse
|
3
|
Grin L, Wijnands S, Besselaar A, van Oorschot L, Vanwanseele B, van der Steen M. The relation between clinical and objective gait scores in clubfoot patients with and without a relapse. Gait Posture 2022; 97:210-215. [PMID: 35995000 DOI: 10.1016/j.gaitpost.2022.07.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/21/2022] [Accepted: 07/30/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Objective gait analysis that fully captures the multi-segmental foot movement of a clubfoot may help in early identification of a relapse clubfoot. Unfortunately, this type of objective measure is still lacking in a clinical setting and it is unknown how it relates to clinical assessment. RESEARCH QUESTION The aim of this study was to identify differences in total gait and foot deviations between clubfoot patients with and without a relapse clubfoot and to evaluate their relationship with clinical status. METHODS In this study, Ponseti-treated idiopathic clubfoot patients were included and divided into clubfoot patients with and without a relapse. Objective gait analysis was done resulting in total gait and foot scores and clinical assessment was performed using the Clubfoot Assessment Protocol (CAP). Additionally, a new clubfoot specific foot score, the clubFoot Deviation Index (cFDI*), was calculated to better capture foot kinematics of clubfoot patients. RESULTS Clubfoot patients with a relapse show lower total gait quality (GDI*) and lower clinical status defined by the CAP than clubfoot patients without a relapse. Abnormal cFDI* was found in relapse patients, reflected by differences in corresponding variable scores. Moderate relationships were found for the subdomains of the CAP and total gait and foot quality in all clubfoot patients. SIGNIFICANCE A new total foot score was introduced in this study, which was more relevant for the clubfoot population. The use of this new foot score (cFDI*) besides the GDI*, is recommended to identify gait and foot motion deviations. Along with clinical assessment, this will give an overview of the overall status of the complex, multi-segmental aspects of a (relapsed) clubfoot. The relationships found in this study suggest that clinical assessment might be indicative of a deviation in total gait and foot pattern, therefore hinting towards personalised screening for better treatment decision making.
Collapse
Affiliation(s)
- Lianne Grin
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001 Heverlee, Belgium; Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, the Netherlands.
| | - Saskia Wijnands
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001 Heverlee, Belgium; Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, the Netherlands
| | - Arnold Besselaar
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, the Netherlands
| | - Lisa van Oorschot
- Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, the Netherlands
| | - Benedicte Vanwanseele
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001 Heverlee, Belgium; Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, the Netherlands
| | - Marieke van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, the Netherlands
| |
Collapse
|
4
|
Pavone V, Sapienza M, Vescio A, Caldaci A, McCracken KL, Canavese F, Testa G. Early developmental milestones in patients with idiopathic clubfoot treated by Ponseti method. Front Pediatr 2022; 10:869401. [PMID: 36090581 PMCID: PMC9448959 DOI: 10.3389/fped.2022.869401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/02/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Idiopathic clubfoot, also referred to as congenital talipes equinovarus (CTEV), is one of the most common lower limb deformities observed in newborns, leading to significant functional impairment if untreated. The aims of this study were to (1) assess the developmental milestones in patients with CTEV treated by the Ponseti technique, and to compare them to the unaffected controls; (2) evaluate the possible correlation between developmental milestones, severity of the deformity, and number of casts. MATERIALS AND METHODS Seventy-nine subjects were divided into two groups, CTEV group (43 patients; 72 feet) and control group (36 patients). Age, sex, affected side, attainment of babbles (BAL), independent gait (IG), and combined word (CW) were recorded for all patients. In patients with CTEV, Pirani Score (PRS), number of casts (NC), and clinical outcome were collected according to the Clubfoot Assessment Protocol (CAP), The American Orthopedic Foot and Ankle Score (AOFAS), and Foot and Ankle Disability Index (FADI). RESULTS IG was achieved later later than the unaffected controls by 12/43 patients (27.9%) with CTEV and 3/36 patients in the control group (8.3%) (p = 0.04) and in a mean time of 16.8 ± 3.5 months and 13.2 ± 2.7 months, respectively (p = 0.001). In the CTEV group the mean value of CAP was 98.6 ± 4.7, of AOFAS of 98.4 ± 4.4 and of FADI equal to 99.9 ± 0.44. There were no statistically significant differences for BAL and CW; and no correlation with PRS, NC, or clinical score were identified. CONCLUSION CTEV patients managed by the Ponseti technique achieve independent gait later than the unaffected controls, although they do so within the age limit of developmental. On the other hand, the Ponseti treatment has no impact on attainment of language development.
Collapse
Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
| | - Alessia Caldaci
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
| | - Kathryn Louise McCracken
- Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lille, France
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lille, France
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
| |
Collapse
|
5
|
Grin L, van der Steen MC, Wijnands SDN, van Oorschot L, Besselaar AT, Vanwanseele B. Forefoot adduction and forefoot supination as kinematic indicators of relapse clubfoot. Gait Posture 2021; 90:415-421. [PMID: 34583148 DOI: 10.1016/j.gaitpost.2021.09.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Understanding the kinematic characteristics of relapse clubfoot compared to successfully treated clubfoot could aid early identification of a relapse and improve treatment planning. The usage of a multi segment foot model is essential in order to grasp the full complexity of the multi-planar and multi-joint deformity of the clubfoot. RESEARCH QUESTION The purpose of this study was to identify differences in foot kinematics, using a multi-segment foot model, during gait between patients with Ponseti treated clubfoot with and without a relapse and age-matched healthy controls. METHODS A cross-sectional study was carried out including 11 patients with relapse clubfoot, 11 patients with clubfoot and 15 controls. Gait analysis was performed using an extended Helen Hayes model combined with the Oxford Foot Model. Statistical analysis included statistical parametric mapping and discrete analysis of kinematic gait parameters of the pelvis, hip, knee, ankle, hindfoot and forefoot in the sagittal, frontal and transversal plane. RESULTS The relapse group showed significantly increased forefoot adduction in relation with the hindfoot and the tibia. Furthermore, this group showed increased forefoot supination in relation with the tibia during stance, whereas during swing increased forefoot supination in relation with the hindfoot was found in patients with relapse clubfoot compared with non-relapse clubfoot. SIGNIFICANCE Forefoot adduction and forefoot supination could be kinematic indicators of relapse clubfoot, which might be useful in early identification of a relapse clubfoot. Subsequently, this could aid the optimization of clinical decision making and treatment planning for children with clubfoot.
Collapse
Affiliation(s)
- L Grin
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001, Heverlee, Belgium; Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN, Eindhoven, the Netherlands.
| | - M C van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD, Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA, Eindhoven, the Netherlands
| | - S D N Wijnands
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001, Heverlee, Belgium; Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD, Eindhoven, the Netherlands
| | - L van Oorschot
- Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN, Eindhoven, the Netherlands
| | - A T Besselaar
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD, Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA, Eindhoven, the Netherlands
| | - B Vanwanseele
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001, Heverlee, Belgium; Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN, Eindhoven, the Netherlands
| |
Collapse
|
6
|
Fantasia I, Dibello D, Di Carlo V, Colin G, Barbieri M, Belcaro C, Magni E, Faletra F, Laura T, Stampalija T. Prenatal diagnosis of isolated clubfoot: Diagnostic accuracy and long-term postnatal outcomes. Eur J Obstet Gynecol Reprod Biol 2021; 264:60-64. [PMID: 34273754 DOI: 10.1016/j.ejogrb.2021.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/01/2021] [Accepted: 07/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate concordance between prenatal and postnatal diagnosis of congenital talipes equinovarus (cTEV), rates of surgery and postnatal outcomes in relation to the prenatal classification of severity. STUDY DESIGN This is a retrospective observational cohort study on fetuses with a prenatal diagnosis of cTEV between 2004 and 2018. All cases of isolated cTEV in singleton pregnancies were included. Postnatally, the Ponseti method was applied. Children were followed-up postnatally for at least two years, with a specific focus on neurodevelopmental outcome. RESULTS The cohort included 81 fetuses with a prenatal diagnosis of cTEV confirmed postnatally in 86.4% of cases. Concordance between prenatal and postnatal assessment was good for both laterality and degree of severity (k = 0.61 and 0.66, respectively). The average Pirani score, number of casts and rates of Achilles tendon tenotomy were higher for III degree cTEV (p < 0.001). Within this group only, the rate of relapse was 11% and the rates of major surgery was 6%. The postnatal outcome was normal in 68.6% newborns, while 14% of cases had a diagnosis of minor additional findings and 17% had an impairment of neurological development. None of the outcome was statistically correlated to the prenatal assessment of laterality or degree. CONCLUSIONS The accuracy of prenatal ultrasound for isolated cTEV is 86% with a false positive diagnosis of 14%. The grade of cTEV assigned prenatally correlates to postnatal severity and longer orthopedic rehabilitation in terms of number of casts and need of surgery. The assessment of the correlation between cTEV and neurological impairment requires further prospective studies on larger cohorts.
Collapse
Affiliation(s)
- Ilaria Fantasia
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy.
| | - Daniela Dibello
- Unit of Orthopedics and Traumatology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Valentina Di Carlo
- Unit of Orthopedics and Traumatology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Giulia Colin
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Moira Barbieri
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Chiara Belcaro
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Elena Magni
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", via dell'Istria, 34137 Trieste, Italy
| | - Flavio Faletra
- Department of Medical Genetics, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Travan Laura
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| |
Collapse
|
7
|
Manousaki E, Esbjörnsson AC, Hägglund G, Andriesse H. Development of foot length in children with congenital clubfoot up to 7 years of age: a prospective follow-up study. BMC Musculoskelet Disord 2021; 22:487. [PMID: 34044803 PMCID: PMC8161945 DOI: 10.1186/s12891-021-04323-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Clubfeet are typically shorter than normal feet. This study aimed first to describe the development of foot length in a consecutive series of children with congenital clubfoot and second to relate foot length to development of relapse and motion quality. Methods Foot length was measured every 6 months in 72 consecutive children with congenital clubfoot (29 bilateral) aged from 2 to 7 years. The initial treatment was nonsurgical followed by standardized orthotic treatment. Foot length growth rate was calculated every half year. In children with unilateral clubfeet, the difference in foot length between the clubfoot and the contralateral foot was calculated. Motion quality was evaluated by the Clubfoot Assessment Protocol (CAP). Student’s t test, the Mann–Whitney U test and Spearman’s correlation were used for group comparisons. Bonferroni correction was used when multiple comparisons were performed. Results Clubfeet were smaller (P < 0.001) than reference feet at all ages but had a similar growth rate up to age 7. Unilateral clubfeet with greater difference in size compared with the contralateral foot at the first measurement, relapsed more frequently (P = 0.016) and correlated with poorer motion quality (r = 0.4; P = 0.011). Conclusions As previously reported, clubfeet were smaller than reference feet at all ages. The growth rate, however, was similar between clubfeet and reference feet. Children with unilateral clubfeet and greater foot length difference at 2 years of age had a higher tendency to relapse and poorer motion quality at 7 years of age, indicating that foot length could be used as a prognostic tool.
Collapse
Affiliation(s)
- Evgenia Manousaki
- Department of Clinical Sciences, Lund University, Orthopedics, 221 85, Lund, Sweden.
| | | | - Gunnar Hägglund
- Department of Clinical Sciences, Lund University, Orthopedics, 221 85, Lund, Sweden
| | - Hanneke Andriesse
- Department of Clinical Sciences, Lund University, Orthopedics, 221 85, Lund, Sweden
| |
Collapse
|
8
|
Sport Ability during Walking Age in Clubfoot-Affected Children after Ponseti Method: A Case-Series Study. CHILDREN-BASEL 2021; 8:children8030181. [PMID: 33804306 PMCID: PMC8001402 DOI: 10.3390/children8030181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 01/08/2023]
Abstract
Background: The Ponseti method (PM) of manipulative treatment for congenital talipes equinovarus (CTEV) or clubfoot became widely adopted by pediatric orthopedic surgeons at the beginning of the mid-1990s with reports of long-term successful outcomes. Sports are crucial for children’s development and for learning good behavior. This study aimed to evaluate the sports activity levels in children treated with PM and to assess the different outcomes, according to gender and bilaterality. Methods: A total of 25 patients (44 feet) with CTEV treated by the PM were included in the study. The patients were clinically evaluated according to the Clubfoot Assessment Protocol, American Orthopedic Foot and Ankle Society, Ankle–Hindfoot score, the Foot and Ankle Disability Index (CAP, AOFAS, and FADI, respectively), and FADI Sport scores. Results: The overall mean CAP, AOFAS, FADI, and FADI Sport scores were 97.5 ± 6.4 (range 68.75–100), 97.5 ± 5.8 (range 73.00–100), 99.9 ± 0.6 (range 97.1–100), and 100, respectively. Gender and bilaterality did not affect outcome (p > 0.05). Conclusions: The data confirmed good-to-excellent outcomes in children with CTEV managed by PM. No limitations in sport performance or activity could be observed. In particular, male and female patients and patients with unilateral or bilateral involvement performed equally well.
Collapse
|
9
|
Dillmann J, Schwarzer G, Peterlein CD. Motor and cognitive functioning in children treated for idiopathic clubfoot at the age of 3 years. BMC Pediatr 2019; 19:394. [PMID: 31664958 PMCID: PMC6821002 DOI: 10.1186/s12887-019-1765-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 10/09/2019] [Indexed: 12/12/2022] Open
Abstract
Background Several studies have investigated motor and cognitive skills in infants as well as gross motor abilities in schoolchildren treated for congenital idiopathic clubfoot, mostly indicating specific impairments in those children. However, until now, little is known about the motor and cognitive abilities of preschool children treated for idiopathic clubfoot. Thus, it was the aim of this study to examine gross motor, fine motor and cognitive skills of 3-year-old-children treated for idiopathic clubfoot. Method We tested gross motor, fine motor and cognitive functioning of 10 children treated for idiopathic clubfoot and 10 typically developing children at the age of 40 months (SD = 1) with the Bayley Scales of Infant and Toddler Development. Results The children treated for idiopathic clubfoot showed a slight delay in gross motor development. In particular, they demonstrated difficulties in tiptoeing, walking upstairs and walking downstairs. Moreover, we found some slight deficits in cognitive development, particularly in visual-spatial memory. Discussion Children treated for idiopathic clubfoot appear to have an increased risk of gross motor and spatial cognitive deficits. Orthopedic pediatrics should incorporate measures of gross motor functioning, for example tiptoeing, in their orthopedic setting. Moreover, future studies are needed to clarify whether the observed deficits persist through childhood. If so, some kind of a motor training for children with idiopathic clubfoot might be required.
Collapse
Affiliation(s)
- Julia Dillmann
- Department of Developmental Psychology, Justus-Liebig-University, Otto-Behaghel-Str. 10F, 35394, Gießen, Germany.
| | - Gudrun Schwarzer
- Department of Developmental Psychology, Justus-Liebig-University, Otto-Behaghel-Str. 10F, 35394, Gießen, Germany
| | - Christian-Dominik Peterlein
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstraße, 35043, Marburg, Germany
| |
Collapse
|
10
|
Zanardi A, Fortini V, Abati CN, Bettuzzi C, Salvatori G, Prato E, Di Giacinto S, Lampasi M. Standing and walking age in children with idiopathic clubfoot: French physiotherapy versus Ponseti method. J Child Orthop 2019; 13:471-477. [PMID: 31695814 PMCID: PMC6808080 DOI: 10.1302/1863-2548.13.190097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE A mild delay in gross motor milestones and walking age has been reported in infants with clubfoot. The influence of different treatments on motor development has been poorly investigated. Some parents and physical therapists express concern that the Ponseti method (PM) and its constraints (abduction brace, casts) would affect development more than the French physical therapy method (FM) due to greater immobilization and lesser stimulation.The purpose of this study was to evaluate achievement of three motor milestones (pull-to-standing, cruising and independent walking) in two groups of clubfoot patients treated at two experienced institutes respectively with the PM and FM. METHODS In all, 52 consecutive infants (full-term at birth, mean age at beginning of treatment 24.3 days (sd 10), mean Dimeglio score 12 (sd 3.4)) were prospectively enrolled (26 patients per centre) and followed up to walking age recording milestones. RESULTS The two groups were not different in terms of age at the beginning of treatment (p = 0.067) and rate of tenotomy. Age at tenotomy was significantly lower in the PM group (p = 0.000). Severity (p = 0.004) and number of bilateral cases (p = 0.012) were higher in the PM group. A non-significant difference was found for age of achievement of pull-to-standing (p = 0.109), cruising (p = 0.253) and independent ambulation (p = 0.349) between the two groups. Overall, milestones were achieved approximately two months later than normal population. Sex, severity, laterality and need of tenotomy were not found to significantly influence milestones. CONCLUSION Our results confirmed that infants with clubfoot are expected to have a minimum delay in motor development. Infants treated with the PM and those treated with the FM did not show significant differences in gross motor milestones achievement at walking age. LEVEL OF EVIDENCE Level II - Prospective comparative therapeutic studies.
Collapse
Affiliation(s)
- A. Zanardi
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children’s Hospital, Florence, Italy
| | - V. Fortini
- Department of Paediatric Rehabilitation, Anna Meyer Children’s Hospital, Florence, Italy
| | - C. N. Abati
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children’s Hospital, Florence, Italy
| | - C. Bettuzzi
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children’s Hospital, Florence, Italy
| | - G. Salvatori
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children’s Hospital, Florence, Italy
| | - E. Prato
- Department of Paediatric Rehabilitation, Anna Meyer Children’s Hospital, Florence, Italy
| | - S. Di Giacinto
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children’s Hospital, Florence, Italy
| | - M. Lampasi
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children’s Hospital, Florence, Italy,Correspondence should be sent to M. Lampasi, Anna Meyer Children’s Hospital, Chief of the Department of Paediatric Orthopaedics and Traumatology, Viale Pieraccini 24, 50139, Florence, Italy. E-mail:
| |
Collapse
|
11
|
Gross Motor Skills in Children With Idiopathic Clubfoot and the Association Between Gross Motor Skills, Foot Involvement, Gait, and Foot Motion. J Pediatr Orthop 2019; 39:359-365. [PMID: 31305379 DOI: 10.1097/bpo.0000000000000964] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known regarding gross motor skills (GMS) in children with idiopathic clubfoot (IC). This study describes GMS, specifically foot involvement and asymmetries, and analyses the association between GMS, gait, and foot status in children with IC. METHODS Gross motor tasks and gait were analyzed in children with IC and typically developed (TD) children. GMS were assessed using videotapes and the Clubfoot Assessment Protocol (CAP). The Gait Deviation Index (GDI) and GDI-Kinetic were calculated from gait analyses. Children were divided into bilateral, unilateral clubfoot, or TD groups. To analyze asymmetries, feet within each group were further classified into superior or inferior foot, depending on their CAP scores. Correlations identified associations between CAP and GDI, GDI-Kinetic, passive foot motion, and Dimeglio Classification Scores at birth in the clubfeet. RESULTS In total, 75 children (mean age, 5 years) were enrolled (bilateral n=22, unilateral clubfoot n=25, TD=28). Children with clubfeet demonstrated significantly lower GMS, gait, and foot motion compared with TD children. One leg standing and hopping deviated in 84% and 91%, respectively, in at least one foot in children with clubfoot. Gross motor asymmetries were evident in both children with bilateral and unilateral involvement. In children with unilateral clubfoot, contralateral feet showed few deviations in GMS compared with TD; however, differences existed in gait and foot motion. The association between GMS and gait, foot motion, and initial foot status varied between poor and moderate. CONCLUSIONS Gross motor deficits and asymmetries are present in children with both bilateral and unilateral IC. Development of GMS of the contralateral foot mirrors that of TD children, but modifies to the clubfoot in gait and foot motion. The weak association with gait, foot motion, and initial clubfoot severity indicates that gross motor measurements represent a different outcome entity in clubfoot treatment. We therefore, recommend gross motor task evaluation for children with IC. LEVEL OF EVIDENCE Level II-prognostic studies.
Collapse
|
12
|
Manousaki E, Esbjörnsson AC, Mattsson L, Andriesse H. Correlations between the Gait Profile Score and standard clinical outcome measures in children with idiopathic clubfoot. Gait Posture 2019; 71:50-55. [PMID: 31005855 DOI: 10.1016/j.gaitpost.2019.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 03/09/2019] [Accepted: 04/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Measures of overall gait deviations such as the Gait Profile Score (GPS) and the Gait Variable Score (GVS) are used to evaluate gait in clinical practice and for research purposes. In the clinical setting, gait deviations are often visually assessed and classified using structured protocols such as the Clubfoot Assessment Protocol (CAP). RESEARCH QUESTION Determine the relationship between measures of overall gait deviations and clinical assessments. METHODS This cross-sectional study evaluated the usability of GPS and GVS in children with idiopathic clubfoot. Twenty consecutively born children with idiopathic clubfoot participated in this study. At 7 years of age, the children were referred for three-dimensional gait analysis and, on the same day, they also underwent a clinical examination according to the CAP. RESULTS The overall gait deviations, expressed as the GPS (overall and affected side) and the GVS for nine key variables were calculated. The correlations between the GPS and values from CAP, its domains, and a single item called walking and between the item walking and the GVS values were analyzed using the Spearman's rank correlation coefficient (rs). The item walking correlated significantly with the GPS (rs = -0.62), and the GVS for foot progression (rs = -0.61) and foot dorsiflexion/plantarflexion (rs = -0.50). The domain "morphology" correlated with the GPS (rs = 0.64). SIGNIFICANCE These findings indicate that the GPS index along with the GVS reflects gait deviations observed clinically in children with clubfoot.
Collapse
Affiliation(s)
- Evgenia Manousaki
- Lund University, Department of Clinical Sciences, Orthopedics, SE 221 85, Lund, Sweden.
| | | | | | - Hanneke Andriesse
- Lund University, Department of Clinical Sciences, Orthopedics, SE 221 85, Lund, Sweden.
| |
Collapse
|
13
|
Abstract
PURPOSE Treatment of idiopathic clubfoot (IC) has improved since the introduction of the Ponseti method. However, relapses are still common and primarily related to non-adherence to the brace regime. Our hypothesis was that IC might be more than just a structural deformity. Based on three studies, the aim of this paper was to provide an overview of findings regarding additional challenges within IC. METHODS In total, 153 children with IC and 137 control children participated in the studies. The first study assessed gross motor skills in six motor tasks using the Clubfoot Assessment Protocol. The second and third studies surveyed neurodevelopmental difficulties (NDDs) using the Five to Fifteen (FTF) questionnaire and health-related quality of life (HRQoL) using the EuroQol-5D youth. RESULTS A high percentage of gross motor deviations were found in children with IC compared with controls, and those correlated poorly with clubfoot severity and foot movement. Children with IC had a higher prevalence of NDDs on the FTF compared with the control group, including the domains: motor skills, perception and language. One-third of children with IC were defined as at risk of developmental disorders. In this subgroup, parents were less satisfied with the outcome of clubfoot treatment and the children reported worse HRQoL than those without NDDs. CONCLUSION The findings suggest additional challenges in children with IC, such as NDDs, apparently affecting both clubfoot treatment outcome and HRQoL. Thus, awareness of these challenges could be vital to further optimize treatment and support, for example, with regards to brace adherence. LEVEL OF EVIDENCE II - Prognostic study.
Collapse
Affiliation(s)
- E. Lööf
- Paediatric Neurology, Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden,Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden,Correspondence should be sent to Elin Lööf, Paediatric Neurology QB:27, Department of Women’s and Children’s Health, Karolinska Institutet, 171 76 Stockholm, Sweden. E-mail:
| |
Collapse
|
14
|
Lööf E, Andriesse H, Broström EW, André M, Bölte S. Neurodevelopmental difficulties in children with idiopathic clubfoot. Dev Med Child Neurol 2019; 61:98-104. [PMID: 30132825 DOI: 10.1111/dmcn.13996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2018] [Indexed: 12/13/2022]
Abstract
AIM To evaluate neurodevelopmental difficulties in children with idiopathic clubfoot. METHOD A cross-sectional study of 106 children (29 females, 77 males; aged 8-10y) with idiopathic clubfoot and 109 age-, sex-, and residential area-parallelized children from the general population. Neurodevelopmental difficulties were assessed using the parent-report Five to Fifteen (FTF) questionnaire. Group differences were analysed for FTF domains, subdomains, and items. The 90th centile cut-off of the general population on FTF and the parent-based disease-specific instrument (DSI) were used to evaluate clinical relevance of neurodevelopmental symptoms in idiopathic clubfoot. RESULTS Modest group differences were found for several FTF domains (motor skills, perception, and language) and subdomains (gross and fine motor skills, relation in space, comprehensive and expressive language skills). Thirty-one per cent of the children with idiopathic clubfoot scored in the clinically significant range on 2 or more FTF domains. DSI scores were lower in this subgroup. INTERPRETATION Findings indicate a moderate and selective increase of neurodevelopmental difficulties in children with idiopathic clubfoot as a whole, especially in the areas of motor skills, perception, and language. Idiopathic clubfoot with marked neurodevelopmental symptoms are associated with less satisfaction of the clubfoot treatment. Our results recommend awareness of neurodevelopmental difficulties in the assessment and treatment of idiopathic clubfoot. WHAT THIS PAPER ADDS A substantial minority of children with idiopathic clubfoot show neurodevelopmental difficulties. Children with idiopathic clubfoot might present additional difficulties in motor skills, perception, and language. Children with idiopathic clubfoot and marked neurodevelopmental symptoms show poorer parent-reported clubfoot treatment satisfaction. Neurodevelopmental difficulties should be considered in clinical practice of idiopathic clubfoot.
Collapse
Affiliation(s)
- Elin Lööf
- Division of Neurology/Orthopedics/Reumatology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | | | - Eva W Broström
- Division of Neurology/Orthopedics/Reumatology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Pediatric Neurology and Musculoskeletal Disorders and Home Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Marie André
- Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Division of Neuropsychiatry, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
| |
Collapse
|
15
|
Aulie VS, Halvorsen VB, Brox JI. Motor abilities in 182 children treated for idiopathic clubfoot: a comparison between the traditional and the Ponseti method and controls. J Child Orthop 2018; 12:383-389. [PMID: 30154930 PMCID: PMC6090191 DOI: 10.1302/1863-2548.12.170195] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of the study was to examine motor abilities in children treated for idiopathic clubfoot with either the traditional extensive surgery method or the Ponseti method, and compare their motor skills with a control group without clubfoot. METHODS A total of 89 children treated according to the traditional method (mean age 9.0 years, 7 to 10) and 93 treated ad modum Ponseti (mean age 8.8 years, 7 to 10) were recruited from a multicentre clinical study in Norway. A total of 45 age-matched children without clubfoot were recruited from a nearby school. They were all assessed with the Movement Assessment Battery for Children - Second Edition (MABC-2), which evaluates motor performance. We applied Analysis of Covariance for comparison of the two treatment methods and adjusted for gender, laterality, comorbidity, achillotomy or more extended surgery, physiotherapy and the age when the child walked independently. RESULTS We found no significant difference in any of the various components or the total score of the MABC-2 between patients treated with the two different methods. In all, 76% of the children treated according to the traditional method and ad modum Ponseti, and 96% in the control group, respectively, were classified as having normal motor abilities. CONCLUSION About three-quarters of children aged nine years and treated for idiopathic clubfoot had normal motor abilities. We found similar results in patients treated with the traditional method and the Ponseti method. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- V. S. Aulie
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Box 4956 Nydalen, 0424 Oslo, Norway, Correspondence should be sent to V. S. Aulie, Oslo University Hospital, Box 4956 Nydalen, 0424 Oslo, Norway.
| | - V. B. Halvorsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Box 4956 Nydalen, 0424 Oslo, Norway
| | - J. I. Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Box 4956 Nydalen, 0424 Oslo, Norway,Medical Faculty, University of Oslo, 0316 Oslo, Norway
| |
Collapse
|
16
|
Morales-Osorio G, Lomeli-Gonzalez J, Hernandez-Valadez NI, Saldana EA, Arenas-Sordo ML. Electrostimulation to Increase Peroneal Muscle Strength in Pediatric Patients With Postsurgical Clubfoot. JOURNAL OF PEDIATRICS REVIEW 2016. [DOI: 10.17795/jpr-2852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
17
|
Abstract
Although the main aim of clubfoot correction is to create a foot without limitations in daily activities and sport, studies on the walking capacity of children with corrected clubfeet are rare. In this cross-sectional study, the outcome of the six-minute walking test in 44 children with clubfeet (16 unilateral and 28 bilateral, mean age 8.57±2.45 years) was compared with the reference values of Geiger, clinical status measured with the Clubfoot Assessment Protocol (CAP), and regression analysis used to calculate which CAP subgroup predicts walking capacity. The mean walking capacity was decreased to 79% (P<0.001) and was not influenced by unilaterality or bilaterality (P=0.437). The subgroup CAP morphology was a significant predictor (R=0.103; P=0.034). Knowing that walking capacity is only slightly decreased can help adjust expectations and set goals for training.
Collapse
|
18
|
Abstract
PURPOSE To investigate the effect of treated clubfoot disorder on gross motor skill level measured by the Alberta Infant Motor Scale (AIMS). METHODS Fifty-two babies participated: 26 were treated for idiopathic clubfoot (12 with the Ponseti treatment method, 9 with the French physical therapy technique, and 5 with a combination of both methods); 26 were babies who were typically developing and without medical diagnoses. The AIMS was administered at 3-month intervals. RESULTS No significant differences in AIMS scores were found between the clubfoot and control groups at 3 and 6 months, but at 9 and 12 months the clubfoot group scored significantly lower. Babies who were typically developing were significantly more likely to be walking at 12 months than babies with clubfoot. CONCLUSIONS Treated clubfoot was associated with a mild delay in attainment of gross motor skills at 9 and 12 months of age.
Collapse
|