Symmetry of Shoe Size and Calf Girth in Children With Treated Idiopathic Clubfoot: A Longitudinal Study.

BACKGROUND: Treatments for idiopathic clubfoot focus on obtaining a functional foot, typical gait pattern, and activity participation. Patients and families are also concerned about practical considerations regarding shoe wear and the appearance of the calf. The purpose of this study was to quantify whether children treated for idiopathic clubfoot have symmetry differences in shoe size and calf girth when presenting with unilateral versus bilateral involvement. METHODS: Participants with a diagnosis of idiopathic clubfoot (treated with Ponseti or French functional methods) were prospectively recruited along with children who are typically developing. Shoe size and calf girth were measured at 5, 7, and 10 years of age. RESULTS: Sixty-five participants, 45 with a diagnosis of idiopathic clubfoot (26 unilateral and 19 bilateral) and 20 who were typically developing, began the study at age 5. Children with clubfoot treated with the Ponseti versus French methods showed no differences in shoe size asymmetry, calf girth asymmetry, or absolute calf girth at age 5. Participants with unilateral clubfoot demonstrated an average of 1.5 size smaller shoes for the involved side at all 3 ages. Participants with bilateral clubfeet had a significantly smaller, <0.75 size difference between both feet. Participants with unilateral clubfoot demonstrated about a 2 cm smaller calf girth on the involved side compared with the uninvolved side at all 3 ages. Participants with bilateral clubfeet had a smaller, <0.5 cm calf difference between sides. Calf girths for involved limbs were significantly smaller than for uninvolved limbs. CONCLUSIONS: Children with unilateral clubfeet can expect to need a smaller shoe on their involved side. Children with bilateral clubfeet can expect a minimal shoe size discrepancy between limbs. All limbs with clubfoot involvement can expect to have a smaller calf girth than limbs that are typically developing. LEVEL OF EVIDENCE: Level II. This is considered a prognostic study-investigating the effect of a treated clubfoot on shoe size and calf girth. This is a lesser-quality prospective study in which <80% of persons completed follow-up.