Gait Analysis of Children Treated for Clubfoot with Physical Therapy or the Ponseti Cast Technique

Abstract

While the rate of normal kinematic ankle motion in the sagittal plane was 65% in the group treated with physical therapy, the gait abnormalities that were seen in that group were characterized by mild equinus and/or footdrop. The rate of normal kinematic ankle motion in the sagittal plane was 47% in the cast-treatment group, but the most common gait abnormality in this group was mildly increased dorsiflexion in the stance phase. The rates of calcaneus gait and equinus gait were <or=15% in each nonoperative group. The differences between the physical therapy and cast-treatment groups may, in part, be the result of the percutaneous Achilles tendon lengthening that is performed as part of the Ponseti cast technique but not as part of the physical therapy program.

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

“…Kinematic parameters that were greater than one standard deviation from age-matched normal control data were noted. This allowed comparison and consistency with previous reports of gait analysis in clubfoot patients at age 2 from our center [14]. Ankle equinus, increased ankle dorsiflexion, foot drop, and calcaneus at age 5 years were defined (Table 1).…”

“…These were taken from the earlier reported group of 182 patients (273 feet) [14]. Due to the increased size of the children resulting in increased step lengths, kinetic data (ie, ankle and hip power generation) could now be compared between the two treatment methods, age-matched children with normal feet, and patients who had surgical correction.…”

“…The average score of Dimeglio et al [11] for the three groups was 12.8 (range, [10][11][12][13][14][15] for the feet treated with the Ponseti method, 12.9 (range, 10-17) for those treated with the French method, and 14.1 (range, 10-17) for those feet that had undergone a surgery. There was no difference (p [ 0.05) in initial severity of deformity as rated by the score of Dimeglio et al [11] between the nonsurgical feet treated with the French PT method versus the Ponseti method, however feet that eventually required surgery were initially more severe (p = 0.0002) than those that did not.…”

“…Likewise, reports from Bensahel et al [4] and Dimeglio et al [12] demonstrate the correction may be obtained with the French technique. Few reports of radiographic results are present in the literature [14,27,28], with even fewer reports of functional outcomes following treatment [14].…”

“…In 2008, our institution reported the gait characteristics of 105 2-year-old patients (154 feet) treated nonoperatively for clubfoot using instrumented motion analysis [14]. The data suggested 15% of the feet treated with the French physical therapy program had residual ankle equinus during stance phase, and 19% had a subtle foot drop in swing phase.…”