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Long-Term Outcome Evaluation in Young Adults Following Clubfoot Surgical Release

Graf, Adam MS*; Hassani, Sahar MS*; Krzak, Joseph PT, PCS*; Long, Jason PhD; Caudill, Angela MPT; Flanagan, Ann PT, PCS; Eastwood, Daniel MS; Kuo, Ken N. MD§ ∥; Harris, Gerald PhD, PE* ‡; Smith, Peter MD*

Journal of Pediatric Orthopaedics: June 2010 - Volume 30 - Issue 4 - pp 379-385
doi: 10.1097/BPO.0b013e3181d8fbd7
Upper/Lower Extremity

Background: The aim of this study was to evaluate the long-term outcome of a comprehensive surgical release for congenital talipes equinovarus (CTEV).

Methods: Gait, strength, segmental foot motion, and outcomes questionnaire data were collected on 24 adults (21.8±2.3 y) who were surgically treated for CTEV as infants. These data were statistically compared with of 48-age group matched controls (23.2±2.4 y).

Results: The clubfoot group was functional in activities of daily living, although most patients did experience foot pain after a day of typical activities, such as walking, standing, using stairs and doing exercise. Lower extremity gait kinematics was similar to the control group. There were differences in segmental foot motion with the hindfoot in a more plantarflexed position relative to the tibia and the forefoot dorsiflexed, and adducted relative to the hindfoot. Ankle plantarflexion and inversion strength and range of motion was reduced in the clubfoot group in association with an increase in hip power generation during the preswing and initial swing phases of the gait cycle.

Conclusions: Surgical correction of CTEV was successful in providing a functional plantigrade foot as the patients reached adulthood. However, limitations included foot pain, limited foot range of motion, and weakness.

Level of Evidence: Level III.

*Shriners Hospitals for Children, Chicago, IL

Orthopaedic & Rehabilitation Engineering Center (OREC) Marquette University/Medical College of Wisconsin

Medical College of Wisconsin, Milwaukee, WI

§National Health Research Institutes, Zhunan

National Taiwan University Hospital, Taipei, Taiwan

Funding Source: US Department of Education National Institute on Disability and Rehabilitation Research (NIDRR) Grant ♯ H133G060252.

Reprints: Adam Graf, MS, Shriners Hospitals for Children, 2211 North Oak Park Ave, Chicago, IL 60707. E-mail: agraf@shrinenet.org.

© 2010 Lippincott Williams & Wilkins, Inc.