Clinical Bottom Line
“How should I apply this information?”
Children who are actively managed for idiopathic clubfoot through casting and therapy will likely have gross motor milestones closely matched to typically developing peers at 3 to 6 months of age. As the upright expectations of gross motor mobility increase, there will likely be a slight lag in skill development at 9 to 12 months. The specific skill of independent walking will almost always be attained by 18 months. When this walking milestone is not achieved by 18 months, referral to early intervention and for further diagnostic work-up is indicated. Educating parents to the expected differences and giving them strategies to enhance skills may be helpful. Family education should include activities that enhance upright control with and without bracing.
“What should I be mindful about in applying this information?”
There is a potential for delay in gross motor skills during the first 18 months when a child has an idiopathic clubfoot, but the severity of the clubfoot does not affect the significance of delay. The relationship between early treatment and development of gross motor skills beyond 18 months is not reported. Babies being managed in bracing may not spend as much time in upright weight bearing which is important for natural development of trunk control as well as hip and ankle strategies. Work on upright control should also emphasize normal foot alignment so the child is strengthening in the correct alignment, rather than a position of equinovarus. Early gross motor development is similar in babies treated with the Ponseti Technique and the French Technique for clubfoot management. Although no differences between treatment methods were found, the authors could not report on the effect of family compliance with treatment protocols. Noncompliance may exacerbate gross motor delays. No relapse of clubfoot was noted in this study but one must assume that clubfoot relapse could interfere with gains in gross motor skills.
Maureen Donohoe, PT, DPT, PCS
Alfred I. duPont Hospital for Children,
Nancy Lennon, MS, PT
Nemours Biomedical Research,