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

Mindler, Gabriel T. MD; Kranzl, Andreas PhD; Lipkowski, Charlotte A.M. MD; Ganger, Rudolf MD, PhD; Radler, Christof MD

Journal of Bone & Joint Surgery - American Volume: 1 October 2014 - Volume 96 - Issue 19 - p 1593–1599
doi: 10.2106/JBJS.M.01603
Scientific Articles
Supplementary Content
Disclosures

Background: The aim of the study was to evaluate how clubfeet treated with the Ponseti method compare with control feet in gait analysis and whether additional information can be provided by the Oxford foot model.

Methods: All patients with a minimum age of three years in our prospective database of clubfeet treated with the Ponseti method were considered for inclusion. Exclusion criteria were an associated syndrome or neurological disease, positional (slight) clubfoot, and presentation at an age of more than three months. Of the 125 patients with 199 clubfeet who satisfied the criteria, thirty-six (29%) agreed to participate in the study. Four of these were excluded because of insufficient gait analysis data, leaving thirty-two patients with fifty clubfeet for evaluation. Clinical examination and three-dimensional gait analysis including the Oxford foot model were performed, and a disease-specific questionnaire was administered. Kinetic and kinematic results were compared with those of an age-matched control group (n = 15).

Results: The mean score on the disease-specific questionnaire was 83.5. Gait analysis showed significantly decreased range of motion, plantar flexion, and power of the ankle compared with controls. The mean external foot progression angle of 5.7° in the Ponseti group was slightly less than that in the controls. Slight intoeing occurred in 24%, and 12% did not achieve a neutral position during swing phase. Slight compensation was observed, including external rotation of the hip in 28%. The Oxford foot model revealed differences in foot motion between the groups.

Conclusions: Clubfoot treatment with the Ponseti method yielded good clinical results with high functional scores. Three-dimensional gait analysis demonstrated distinctive but slight deviations. Intoeing was less frequent and less severe compared with groups in the literature. We recommend the use of three-dimensional gait analysis, including a foot model, as an objective tool for evaluation of the results of clubfoot treatment.

Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

1Department of Pediatric Orthopaedics (G.T.M., R.G., and C.R.), Laboratory for Gait and Movement Analysis (A.K.), Orthopaedic Hospital Speising, Speisinger Strasse 109, A-1130 Vienna, Austria. E-mail address for C. Radler: christof.radler@oss.at

2Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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