Gait Analysis after Initial Nonoperative Treatment for Clubfeet: Intermediate Term Followup at Age 5

Abstract

We conducted gait analysis following initial nonoperative clubfoot treatment to compare lower extremity kinematic (eg, ankle motion) and kinetic (eg, ankle power) characteristics between patients treated as infants with Ponseti casting or French physical therapy. This is a followup report of gait characteristics at age 5 years in patients who had previously been tested at age 2 years. One hundred-twenty five clubfeet in 90 patients (34 feet only Ponseti treatment, 40 only French PT, and 51 feet initial nonoperative treatment followed by surgery) were included. The gait characteristics were compared to those of age-matched normal control subjects. Ankle equinus during gait occurred in 5% of feet treated with the French method and none of those treated by the Ponseti method. Increased stance phase ankle dorsiflexion persisted in 24% of feet treated by the Ponseti method. Intoeing was seen in 1 . 3 of both the French and Ponseti methods. Ankle push-off power was decreased compared to normal in patients treated by both methods, and even more so in operated feet. The presence or absence of Achilles tenotomy did not affect ankle power. Gait characteristics of feet that did not have surgery and maintained correction were superior to those of operated feet.

A comprehensive outcome comparison of surgical and Ponseti clubfoot treatments with reference to pediatric norms

“…Surgical treatment provides a high percentage of short-term, clinically satisfactory radiological results [3]; however, long-term follow-up results, based on examinations, questionnaires, radiographic analyses [4,5], and kinematics [6], are disappointing. Currently, most physicians agree that extensive soft-tissue release surgeries (joint invasive) should be avoided and that a more conservative, joint-sparing approach should be considered first [5,[7][8][9][10][11][12][13].…”

Results of Gait Analysis Including the Oxford Foot Model in Children with Clubfoot Treated with the Ponseti Method

“…Gait analysis following clubfoot treatment has primarily been used in studies involving operatively treated patients [6][7][8][9][10][11][12][13][14][15][16][17][18] ; few have evaluated the Ponseti method in this fashion [19][20][21][22][23][24] . Special foot models allow more detailed evaluation of the foot and of treatment outcomes 11,15,[23][24][25] .…”

Assessment of Clubfoot Treatment Using Movement Analysis

“…While the Achilles tenotomy was not initially included in the protocol, more recent recommendations have been made for correction of residual equinus by gastrocnemius fascial lengthening or heel cord tenotomy as needed in select infants with resistant feet. 3,4 The French technique requires a trained physical therapist and a committed family for success. This program is still in existence in our center as well as in areas of Europe.…”

“…4 El Hawaray et al found that nearly 30% of feet had undergone surgery by the age of 2 years. 3 The gait findings in these patients were not included in the 2008 publication.…”