Gross Motor Skills in Children With Idiopathic Clubfoot and the Association Between Gross Motor Skills, Foot Involvement, Gait, and Foot Motion.

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.

Neurodevelopmental difficulties negatively affect health-related quality of life in children with idiopathic clubfoot.

AIM: To study health-related quality of life (HRQoL) in children with idiopathic clubfoot (IC) and the influence of sex, clubfoot laterality and neurodevelopmental difficulties (NDD) on HRQoL. METHODS: A cross-sectional questionnaire-based study in Stockholm and Skåne Counties, Sweden, of 106 children with IC born 2004-2007 (mean 9.4 ± 0.6 years) and a general population sample of 109 schoolchildren (mean 9.5 ± 0.6 years). The children and their caregivers answered the EQ-5D-Y (Youth) and Five to Fifteen questionnaires to operationalise HRQoL and NDD, respectively. RESULTS: No reduced HRQoL on the EQ-5D-Y dimensions were reported by 51% of the children with IC, and 71% in the general population sample, with significant more problems in the IC sample regarding 'mobility', 'doing usual activities' and 'having pain or discomfort', despite similar overall health status. Neither sex nor clubfoot laterality affected HRQoL. Children with IC and NDD combined reported more problems in three out of five dimensions and lower overall health status compared with children with IC alone. CONCLUSION: Despite similar overall health status, children with IC had more HRQoL problems compared with the general population, being associated with coexisting NDD but not sex or clubfoot laterality.

Gait in 5-year-old children with idiopathic clubfoot: A cohort study of 59 children, focusing on foot involvement and the contralateral foot.

Background and purpose - Idiopathic clubfoot can be bilateral or unilateral; however, most studies of gait have assessed clubfoot cases as one uniform group. The contralateral foot in children with unilateral clubfoot has shown deviations in pedobarographic measurements, but it is seldom included in studies of gait. We evaluated gait in children with idiopathic clubfoot, concentrating on foot involvement. Patients and methods - Three-dimensional gait analyses of 59 children, mean age 5.4 years, with bilateral (n = 30) or unilateral (n = 29) idiopathic clubfoot were stratified into groups of bilateral, unilateral, or contralateral feet. Age-matched controls (n = 28) were evaluated for comparison. Gait assessment included: (1) discrete kinematic and kinetic parameters, and (2) gait deviation index for kinematics (GDI) and kinetics (GDI-k). Results - No differences in gait were found between bilateral and unilateral idiopathic clubfoot, but both groups deviated when compared to controls. Compared to control feet, contralateral feet showed no deviations in discrete gait parameters, but discrepancies were evident in relation to unilateral clubfoot, causing gait asymmetries in children with unilateral involvement. However, all groups deviated significantly from control feet according to GDI and GDI-k. Interpretation - Bilateral and unilateral idiopathic clubfoot cases show the same persistent deviations in gait, mainly regarding reduced plantarflexion. Nevertheless, knowledge of foot involvement is important as children with unilateral clubfoot show gait asymmetries, which might give an impression of poorer deviations. The results of GDI/GDI-k indicate global gait adaptations of the contralateral foot, so the foot should preferably not be used as a reference for gait.

Growth guidance of angular lower limb deformities using a one-third two-hole tubular plate.

PURPOSE: The eight-plate system for angular deformity correction is well known, reliable and effective at any age during growth. Due to high implant costs, we sought to evaluate the effectiveness and safety of a less expensive alternative. METHODS: Between 2006 and 2011, 41 children with angular deformities were managed using a two-hole one-third tubular plate in cases where an eight plate would normally be indicated. Inclusion criteria in this retrospective study were: genu valgum and genu varum. X-ray documentation was performed before and after surgery and patients were followed clinically every 3 months after surgery. The cost per implant was 361.40 Sfr (Swiss Francs) compared to the eight plate at 737 Sfr. RESULTS: Mean time for correction was 13 months. A mean LDFA/MPTA after correction of 89.9°/86.8° was recorded, as well as a mean correction angle of 6.8°/6.6°. The complication rate was 6.6 % (one superficial wound infection and one insufficient correction in an older child). These results compare favourably with published data on the eight plate. CONCLUSION: The two hole one-third tubular plate seems to be a clinically and also cost effective alternative to the eight plate. Full deformity correction is gained for a fraction of the cost. LEVEL OF EVIDENCE: Level III.

Pedobarographic analysis following Ponseti treatment for congenital clubfoot.

UNLABELLED: Current methods of treating congenital clubfeet provide high rates of functional outcomes. Despite the clinical outcomes, radiographic assessment suggests residual equinus deformity of the hindfoot. It is unclear whether these deformities result in abnormal foot-floor pressures and whether they correlate with clinical outcome. We evaluated 28 feet in 20 patients following Ponseti treatment for clubfoot by clinical and pedobarographic examination a mean of 33 months after removal of the last cast. The data were compared to age- and weight-matched normal subjects and to the unaffected foot in the unilaterally affected patients. Despite ankle range of motion of 30 degrees and a physiologic hindfoot valgus alignment in 19 cases, pedobarography suggested differences in maximum force, impulse, contact area, and peak pressure compared to normal subjects. Compared to the unaffected foot the only difference was reduced peak pressure over the medial hindfoot and forefoot with increased pressure over the lateral midfoot. Similar to radiographic abnormalities in studies on treated clubfeet with good functional outcome, pedobarographic analyses show differences compared to a control group. The value of pedobarographic analysis for predicting successful treatment of congenital clubfoot is questionable since it does not correlate with the clinical outcome in patients treated with the Ponseti method. LEVEL OF EVIDENCE: Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.