Gait Analysis Characteristics in Relapsed Clubfoot

Abstract

Background: Relapse rates of clubfoot deformity after initial correction range between 19% and 68% regardless of treatment approach. Most studies focus on relapse before age 4. Little research has focused on late clubfoot relapse. The purpose of this study was to compare the gait characteristics of children with late clubfoot relapse (age ≥5 y) following treatment with the Ponseti method only compared with intra-articular and extra-articular surgeries. Methods: A retrospective review was conducted of all patients with idiopathic clubfoot ≥5 years old who underwent computerized gait analysis for clubfoot relapse between 2001 and 2021. Joint range of motion, muscle strength, gait kinematics, and kinetics were compared among 3 groups based on prior clubfoot treatment: (1) Ponseti casting, (2) Extra-articular (EA) surgery, and (3) Intra-articular (IA) surgery. Results: Sixty-eight subjects (107 feet) were included (39 bilateral). Thirty-one percent of feet had been treated with Ponseti casting alone; 57% had IA surgery, and 12% had EA surgery. The average age when presenting with late relapse was 8.2 years, 9.0 years and 10.7 years for the Ponseti, and IA and EA groups, respectively. The IA group had greater passive dorsiflexion than the other 2 groups (P<0.002), greater inversion weakness than the other 2 groups (P<0.0001), greater dorsiflexion during the stance phase of gait compared with the Ponseti group (P=0.001), and lower maximum power production at push-off compared with the other 2 groups (P=0.009). Conclusion: Late relapse can occur after all types of clubfoot correction. Consistent with existing literature, patients who have undergone posteromedial release surgery have significantly greater plantarflexor weakness resulting in poorer plantarflexor moment and power production during gait. Level of Evidence: Level III, retrospective comparative study.

Clubfoot Twin Study with Wearable GaitUp Sensors and Footscan V9

“…the only way to describe subtle deviations from normal, indicating a pending relapse even after 5 years of age [11]. In the literature it is described that in one-sided clubfoot, the contralateral foot cannot consider to be comparable to a normal foot [12,13].…”

Kinematic Gait Impairments in Children with Clubfeet Treated by the Ponseti Method: A Systematic Review and Meta-Analysis

“…With 3D gait analyses, objective kinematic and kinetic parameters of clubfoot patients can be derived [16][17][18]. Ponseti-treated clubfoot patients previously showed impairments in kinetic outcome measures, such as ankle plantar flexor moment and ankle power [19].…”

“…c medial (range). d number of feet with a moderate (5-10), severe(11)(12)(13)(14)(15), or very severe(16)(17)(18)(19)(20) score on the Dimeglio scale, a total of 88 feet has been scaled in Lööf 2016 and 68 feet in Lööf 2019. -no information was provided.…”

Clubfoot Twin Study with Wearable GaitUp Sensors and Footscan V9

“…In our practice with the footscan V9 (kinetics) and the wearable inertial GaitUp sensors (kinematics) we control the therapeutic results of the clubfoot treatment. Digital-quantitative methods are the only way to describe subtle deviations from normal indicating a pending relapse even after 5 years of age [11].…”