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

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 ch...

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Bibliographic Details
Published in:Clinical orthopaedics and related research 2009-05, Vol.467 (5), p.1206-1213
Main Authors: Karol, Lori A., Jeans, Kelly, ElHawary, Ron
Format: Article
Language:English
Subjects:
Achilles Tendon - physiopathology
Achilles Tendon - surgery
Ankle - physiopathology
Biomechanical Phenomena
Case-Control Studies
Casts, Surgical
Child, Preschool
Clubfoot - physiopathology
Clubfoot - surgery
Clubfoot - therapy
Conservative Orthopedics
Follow-Up Studies
Gait
Humans
Medicine
Medicine & Public Health
Musculoskeletal Manipulations
Orthopedic Procedures
Orthopedics
Prospective Studies
Range of Motion, Articular
Recovery of Function
Sports Medicine
Surgery
Surgical Orthopedics
Symposium: Clubfoot: Etiology and Treatment
Treatment Outcome
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Summary: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.
ISSN:0009-921X
1528-1132
DOI:10.1007/s11999-008-0702-9