Evaluation of a Disease-specific Instrument for Idiopathic Clubfoot Outcome

Dietz, Frederick R.; Tyler, Margaret C.; Leary, Kecia S.; Damiano, Peter C.

doi:10.1007/s11999-008-0700-y

Cited by 44 publications

(44 citation statements)

References 18 publications

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“…The DSI score was introduced by Roye et al [17] and was validated by Dietz et al [20]. The latter [20] compared the DSI of 62 clubfoot patients after joint-invasive surgery and joint-sparing treatment at an age between five and 12 years. They reported a DSI score of 75 points for the joint-invasive group and 85.1 points for the joint-sparing treatment group.…”

Section: Discussionmentioning

confidence: 99%

Midterm results of the Ponseti method in the treatment of congenital clubfoot

Radler

Mindler

Riedl

et al. 2013

International Orthopaedics (SICOT)

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Purpose The Ponseti method has become the gold standard for clubfoot treatment. Although promising short-term results have been published, only a few studies report results at the end of the bracing period. We aimed to evaluate the functional midterm results, rate of recurrence and need for subsequent surgery. Methods Patients from our prospective database of clubfeet treated with the Ponseti method with a minimum age of three years were identified. Exclusion criteria were syndrome or neurogenic association, address in a foreign country, presentation after six weeks of age, more than three casts applied elsewhere and correction with less than three casts. A total of 125 patients met the inclusion criteria. The Pediatric Outcomes Data Collection Instrument (PODCI), the disease-specific instrument (DSI) questionnaire and an invitation for a clinical examination were sent out. For patients not presenting for evaluation, data from the last follow-up were extracted. Results Seventy questionnaires (56 %) of patients with a mean age of 5.7 years (3.3-8.9 years) were returned. The DSI score (n=65) was 85.3 (± 13.01 SD) and the PODCI score (n=59) was 95.5 (± 6.3 SD). A total of 113 of 125 patients (90.4 %) with 182 clubfeet were examined in the study or seen in follow-up. During a mean follow-up of 5.2 years (range 3-8.5 years) a repeat tenotomy was performed in 4 % of cases, a percutaneous Achilles tendon lengthening in 3 %, a tibialis anterior tendon transfer in 13 % and open joint surgery in 5 %. The mean dorsiflexion with knee extended was 15.9°(range 0-32°; SD ±5.5) with 16 feet (9 %) presenting less than 10°. Conclusions The functional scores indicate that the Ponseti method results in mostly pain-free feet not limiting ageappropriate activity. In this consecutive case series open joint surgery could be avoided in 95 % of cases with a good functional and anatomic outcome.

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Section: Discussionmentioning

confidence: 99%

Midterm results of the Ponseti method in the treatment of congenital clubfoot

Radler

Mindler

Riedl

et al. 2013

International Orthopaedics (SICOT)

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“…We found that children awaiting tibialis anterior tendon transfer had worse function and satisfaction than children not undergoing tibialis anterior tendon transfer surgery. Dietz et al [3] reported that children who previously underwent joint-sparing surgery had better disease-specific instrument outcomes than children who underwent joint invasive surgery. Total disease-specific instrument scores of the tibialis anterior tendon transfer group at 12-month followup were similar to those of the joint-sparing surgery group reported by Dietz et al (p = 0.379).…”

Section: Discussionmentioning

confidence: 99%

“…Function and satisfaction were assessed using the diseasespecific instrument for clubfoot questionnaire [3,22], and quality of life was assessed using the Infant Toddler Quality of Life Questionnaire TM (www.healthact.com/itqol.php) [18].…”

Section: Outcome Measuresmentioning

confidence: 99%

Is Tibialis Anterior Tendon Transfer Effective for Recurrent Clubfoot?

Gray

Burns

Little

et al. 2013

Clin Orthop Relat Res

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Background Tibialis anterior tendon transfer surgery forms a part of Ponseti management for children with congenital talipes equinovarus who, after initial correction, present with residual dynamic supination. Although retrospective studies support good outcomes, prospective longitudinal studies in this population are lacking. Questions/purposes We assessed strength, plantar loading, ROM, foot alignment, function, satisfaction, and quality of life in patients with clubfoot that recurred after Ponseti casting who met indications for tibialis anterior tendon transfer surgery, and compared them with a group of patients with clubfoot treated with casting but whose deformity did not recur (therefore who were not indicated for tibialis anterior tendon transfer surgery).Methods Twenty children with idiopathic congenital talipes equinovarus indicated for tibialis anterior tendon transfer surgery were recruited. Assessment at baseline (before surgery), and 3, 6, and 12 months (after surgery) included strength (hand-held dynamometry), plantar loading (capacitance transducer matrix platform), ROM (Dimeglio scale), foot alignment (Foot Posture Index Ó ), function and satisfaction (disease-specific instrument for clubfoot), and quality of life (Infant Toddler Quality of Life Questionnaire TM ). Outcomes were compared with those of 12 age-matched children with congenital talipes equinovarus not indicated for tibialis anterior tendon transfer surgery. Followup was 100% in the control group and 95% (19 of 20) in the tibialis anterior transfer group. Results At baseline, the tibialis anterior tendon transfer group had a significantly worse eversion-to-inversion strength ratio, plantar loading, ROM, foot alignment, and function and satisfaction. At 3 months after surgery, eversion-to-inversion strength, plantar loading, and function and satisfaction were no longer different between groups. Improvements were maintained at 12 months after surgery (eversion-to-inversion strength mean difference, 8% body weight; 95% CI, À26% to 11%; p = 0.412; plantar loading, p [ 0.251; function and satisfaction, p = 0.076). ROM remained less and foot alignment more supinated in the tibialis anterior tendon transfer group between baseline and followup (p \ 0.001, p \ 0.001). Conclusions Tibialis anterior tendon transfer surgery was an effective procedure, which at 12-month followup restored the balance of eversion-to-inversion strength and resulted in plantar loading and function and satisfaction outcomes similar to those of age-matched children with congenital talipes equinovarus who after Ponseti casting were not indicated for tibialis anterior tendon transfer.

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“…Clubfoot deformity can be unilateral or bilateral (Barry, 2005) Research conducted in the United State shows that the prevalence of clubfoot varies between 0.64 and 6.8 per 1000 live births worldwide (Baker, Chesney, Miedzybrodzka & Maffuli, 2003) while a study by Dietz, Tyler and Leary (2009) …”

Section: Introductionmentioning

confidence: 99%

“…Surgical intervention involves posterior release and posterolateral and posteromedial release (Dietz et al, 2009) while conservative management involves manipulation and casting serial (Ponseti et al, 2009). Surgical intervention is best suited for late diagnosis and complex clubfoot (Sureh, Ahmed & Sharma, 2003) while conservative method is advocated as the first line of treatment for early intervention Morcuende et al, 2004).…”

mentioning

confidence: 99%