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Gross Motor Skills in Children With Idiopathic Clubfoot and the Association Between Gross Motor Skills, Foot Involvement, Gait, and Foot Motion

Lööf, Elin, PT, MSc*,†; Andriesse, Hanneke, PhD; André, Marie, PhD; Böhm, Stephanie, PhD§; Iversen, Maura D., DPT, SD, MPH, FNAP, FAPTA*,∥,¶; Broström, Eva W., PhD*,§

doi: 10.1097/BPO.0000000000000964
Original Article: PDF Only

Background: Little is known regarding gross motor skills (GMS) in children with idiopathic clubfoot (IC). This study describes GMS, specifically foot involvement and asymmetries, and analyses the association between GMS, gait, and foot status in children with IC.

Methods: Gross motor tasks and gait were analyzed in children with IC and typically developed (TD) children. GMS were assessed using videotapes and the Clubfoot Assessment Protocol (CAP). The Gait Deviation Index (GDI) and GDI-Kinetic were calculated from gait analyses. Children were divided into bilateral, unilateral clubfoot, or TD groups. To analyze asymmetries, feet within each group were further classified into superior or inferior foot, depending on their CAP scores. Correlations identified associations between CAP and GDI, GDI-Kinetic, passive foot motion, and Dimeglio Classification Scores at birth in the clubfeet.

Results: In total, 75 children (mean age, 5 years) were enrolled (bilateral n=22, unilateral clubfoot n=25, TD=28). Children with clubfeet demonstrated significantly lower GMS, gait, and foot motion compared with TD children. One leg standing and hopping deviated in 84% and 91%, respectively, in at least one foot in children with clubfoot. Gross motor asymmetries were evident in both children with bilateral and unilateral involvement. In children with unilateral clubfoot, contralateral feet showed few deviations in GMS compared with TD; however, differences existed in gait and foot motion. The association between GMS and gait, foot motion, and initial foot status varied between poor and moderate.

Conclusions: Gross motor deficits and asymmetries are present in children with both bilateral and unilateral IC. Development of GMS of the contralateral foot mirrors that of TD children, but modifies to the clubfoot in gait and foot motion. The weak association with gait, foot motion, and initial clubfoot severity indicates that gross motor measurements represent a different outcome entity in clubfoot treatment. We therefore, recommend gross motor task evaluation for children with IC.

Level of Evidence: Level II—prognostic studies.

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*Department of Women’s and Children’s Health, Karolinska Institutet

Functional Area Occupational therapy and Physiotherapy, Allied Health Professionals Function

§Pediatric Neurology and Musculoskeletal Disorders and Home Care, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden

Department of Orthopedics, Skånes University Hospital, Lund

Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University

Department of Medicine, Section of Clinical Sciences, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

E.L.: concept and design of the study, collection of data, statistical analysis, interpretation of data, drafting of the manuscript. H.A.: design of the study, assessing the study subjects, interpretation of data, critical review of the manuscript. M.A.: design of the study, interpretation of data, critical review of the manuscript. S.B.: design of the study, assessing the study subjects and critical review of the manuscript. M.D.I.: analyzing and interpretation of data, critical review of the manuscript. E.W.B.: concept and design of the study, collection and interpretation of data, and critical review of the manuscript.

Supported by grants from the Doctorial School in Health Care Science at Karolinska Institutet, the Promobila Foundation, “Stiftelsen Frimurare Barnhuset,” “Sällskapet barnavård,” and “Stiftelsen Skobranschens Utvecklingsfond.” The funding sources had no involvement in the study. All authors meet each of the authorship requirements established by the International Committee of Medical Journal Editors (ICMJE).

The authors declare no conflicts of interest.

Reprints: Elin Lööf, PT, MSc, Motion Laboratory Q2:07, Department of Women’s and Children’s Health, Karolinska Institutet, 171 76 Stockholm, Sweden. E-mail:

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