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

• Published in: Journal of bone and joint surgery. American volume 2008-07, Vol.90 (7), p.1508-1516
• Main Authors: El-Hawary, Ron, Karol, Lori A, Jeans, Kelly A, Richards, B Stephens
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Casts, Surgical; Child, Preschool; Clubfoot - diagnosis; Clubfoot - therapy; Diseases of the osteoarticular system; Gait; Humans; Malformations and congenital and or hereditary diseases involving bones. Joint deformations; Manipulation, Orthopedic; Medical sciences; Orthopedic surgery; Physical Therapy Modalities; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.G.00201

BackgroundCurrently, clubfoot is initially treated with nonoperative methods including the Ponseti cast technique and the French functional physical therapy program. Our goal was to evaluate the function of children treated with these techniques.MethodsWe reviewed the cases of 182 patients with idiopathic clubfoot (273 feet) who were initially treated nonoperatively. Seventy-seven patients (119 feet) were excluded because they had either received a combination of nonoperative treatments or had undergone surgery prior to testing. Gait analysis was performed when the children were approximately two years of age. Temporal and kinematic data were classified as abnormal if they were more than one standard deviation from normal.ResultsGait analysis was performed on 105 patients (fifty-six treated with casts and forty-nine treated with physical therapy) with 154 involved feet (seventy-nine treated with casts and seventy-five treated with physical therapy). These patients were an average of two years and three months of age, and their initial Diméglio scores ranged between 10 and 17. No significant differences in cadence parameters were found between the two groups. The rate of normal kinematic ankle motion in the sagittal plane was higher in the group treated with physical therapy (65% of the feet) than it was in the group treated with the Ponseti cast technique (47%) (p = 0.0317). More children treated with physical therapy walked with knee hyperextension (37% of the feet) (p < 0.0001), an equinus gait (15%) (p = 0.0051), and footdrop (19%) (p = 0.0072); only one patient treated with casts walked with an equinus gait, and only three demonstrated footdrop. In contrast, more of the patients in the cast-treatment group demonstrated excessive stance-phase dorsiflexion (48% of the feet) (p < 0.0001) and a calcaneus gait (10%). More feet in the physical therapy group had an increased internal foot progression angle (44% compared with 24% in the cast-treatment group; p = 0.0144) and increased shank-based foot rotation (73% compared with 57% in the cast-treatment group; p = 0.05).ConclusionsWhile 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 mild