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The Relationship Between Gait, Gross Motor Function, and Parental Perceived Outcome in Children With Clubfeet

Karol, Lori A. MD; Jeans, Kelly A. MS; Kaipus, Kimberly A. PT, MPT, PCS

Journal of Pediatric Orthopaedics: March 2016 - Volume 36 - Issue 2 - p 145–151
doi: 10.1097/BPO.0000000000000410
Foot & Ankle

Background: Assessment of children treated nonoperatively for idiopathic clubfoot, has primarily focused on the kinematic and kinetic results measured with gait analysis (GA). Excellent results in ankle motion and push-off power during gait have been reported at age 5; however, the assessment of gross motor function, has not been evaluated. The purpose of this study was to look at the relationship between gait measures, Peabody Developmental Motor Scales and parent-perception of their child’s outcome [measured with the Pediatric Outcomes Data Collection Instrument (PODCI)].

Methods: A total of 81 children with idiopathic clubfoot were seen for both GA and Peabody testing. Children who initially underwent the Ponseti technique (n=29), the French Physical Therapy method (PT) (n=23), and a group of children initially treated nonoperatively, but who required surgical intervention before GA at 5 years of age (n=29) were enrolled. Pearson’s correlation coefficient was used to establish significant relationships between gait variables, Peabody, and PODCI scores.

Results: Gait data showed that the Ponseti treated feet had significantly greater ankle power than feet treated surgically (P=0.0075). The Peabody results showed that the PT feet had higher stationary (P=0.0332) and overall gross motor quotient percent (GMQ%) scores (P=0.0092) than the surgical feet. No differences were found in PODCI scores. Ankle power was weakly correlated to the GMQ% (r=0.29; P=0.0102); however, the GMQ% showed a strong correlation to the parent report of Global Functioning Scale on the PODCI (r=0.48; P=0.0005).

Conclusions: Minimal gait disturbances do not interfere with function or parental assessment of abilities and satisfaction at 5-year follow-up in children with idiopathic clubfeet. Nonoperative correction of clubfeet should be the goal when possible, as the Peabody scores show better function as early as 5 years of age when surgery is not required.

Level of Evidence: Level II—therapeutic.

Texas Scottish Rite Hospital for Children, Dallas, TX

Supported by the Texas Scottish Rite Hospital Research Fund. No outside funding was used.

The authors declare no conflicts of interest.

Reprints: Kelly A. Jeans, MS, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219. E-mail:

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