A Longitudinal Review of Gait Following Treatment for Idiopathic Clubfoot: Gait Analysis at 2 and 5 Years of Age
BACKGROUND:Initial correction following nonoperative (NonOp) treatment for idiopathic clubfoot has been reported in 95% of feet by age 2; however, by age 4, approximately one third of feet undergo surgery due to relapse. The purpose of this study was to assess the longitudinal effect of growth and s...
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| Veröffentlicht in: | Journal of pediatric orthopaedics 2016-09, Vol.36 (6), p.565-571 |
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| container_title | Journal of pediatric orthopaedics |
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| creator | Jeans, Kelly A Erdman, Ashley L Jo, Chan-Hee Karol, Lori A |
| description | BACKGROUND:Initial correction following nonoperative (NonOp) treatment for idiopathic clubfoot has been reported in 95% of feet by age 2; however, by age 4, approximately one third of feet undergo surgery due to relapse. The purpose of this study was to assess the longitudinal effect of growth and surgical (Sx) intervention on gait following NonOp and Sx treatment for clubfoot.
METHODS:Children with idiopathic clubfoot were seen for gait analysis at 2 and 5 years of age. Kinematic data were collected at both visits, and kinetic data were collected at age 5 years. Group comparisons were made between feet treated with the Ponseti casting technique (Ponseti) and the French physical therapy method (PT) and between feet treated nonoperatively and surgically. Comparisons were made between feet treated with a limited release or tendon transfer (fair) and those treated with a full posteromedial release (poor). The α was set to 0.05 for all statistical analyses.
RESULTS:Gait data from 181 children with 276 idiopathic clubfeet were collected at both age 2 and 5 years. Each foot was initially treated with either the Ponseti (n=132) or PT (n=144) method but by the 5-year visit, 30 Ponseti and 61 PT feet required surgery. Gait outcomes showed limitations primarily in the Sx clubfeet. Normal ankle motion was only present in 17% of Ponseti and 21% of PT feet by age 5 following Sx management. Sx PT feet showed persistent intoeing at age 2 and 5. Within the Sx group, feet initially treated with PT had a clinically significant reduction in ankle power compared with those treated initially by the Ponseti method. Feet treated with posteromedial releases had significantly less ankle power than those treated with limited surgery or that remained NonOp at 5 years.
CONCLUSIONS:This longitudinal study shows subtle changes between 2 and 5 years, and continues to support a NonOp approach in the treatment of clubfoot.
LEVEL OF EVIDENCE:Level II—therapeutic. |
| doi_str_mv | 10.1097/BPO.0000000000000515 |
| format | Article |
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METHODS:Children with idiopathic clubfoot were seen for gait analysis at 2 and 5 years of age. Kinematic data were collected at both visits, and kinetic data were collected at age 5 years. Group comparisons were made between feet treated with the Ponseti casting technique (Ponseti) and the French physical therapy method (PT) and between feet treated nonoperatively and surgically. Comparisons were made between feet treated with a limited release or tendon transfer (fair) and those treated with a full posteromedial release (poor). The α was set to 0.05 for all statistical analyses.
RESULTS:Gait data from 181 children with 276 idiopathic clubfeet were collected at both age 2 and 5 years. Each foot was initially treated with either the Ponseti (n=132) or PT (n=144) method but by the 5-year visit, 30 Ponseti and 61 PT feet required surgery. Gait outcomes showed limitations primarily in the Sx clubfeet. Normal ankle motion was only present in 17% of Ponseti and 21% of PT feet by age 5 following Sx management. Sx PT feet showed persistent intoeing at age 2 and 5. Within the Sx group, feet initially treated with PT had a clinically significant reduction in ankle power compared with those treated initially by the Ponseti method. Feet treated with posteromedial releases had significantly less ankle power than those treated with limited surgery or that remained NonOp at 5 years.
CONCLUSIONS:This longitudinal study shows subtle changes between 2 and 5 years, and continues to support a NonOp approach in the treatment of clubfoot.
LEVEL OF EVIDENCE:Level II—therapeutic.</description><identifier>ISSN: 0271-6798</identifier><identifier>EISSN: 1539-2570</identifier><identifier>DOI: 10.1097/BPO.0000000000000515</identifier><identifier>PMID: 25985372</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Arthrometry, Articular - methods ; Child, Preschool ; Clubfoot - diagnosis ; Clubfoot - surgery ; Clubfoot - therapy ; Female ; Gait ; Humans ; Long Term Adverse Effects - diagnosis ; Long Term Adverse Effects - physiopathology ; Long Term Adverse Effects - surgery ; Longitudinal Studies ; Male ; Manipulation, Orthopedic - adverse effects ; Manipulation, Orthopedic - methods ; Manipulation, Orthopedic - statistics & numerical data ; Orthopedic Procedures - methods ; Orthopedic Procedures - statistics & numerical data ; Outcome and Process Assessment (Health Care) ; Prospective Studies ; Range of Motion, Articular ; Recurrence ; Texas</subject><ispartof>Journal of pediatric orthopaedics, 2016-09, Vol.36 (6), p.565-571</ispartof><rights>Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3565-b9bb582d0a99a37d6c13f90ae7708c93e54b40027d3dbded6579a1f4148cb3473</citedby><cites>FETCH-LOGICAL-c3565-b9bb582d0a99a37d6c13f90ae7708c93e54b40027d3dbded6579a1f4148cb3473</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25985372$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jeans, Kelly A</creatorcontrib><creatorcontrib>Erdman, Ashley L</creatorcontrib><creatorcontrib>Jo, Chan-Hee</creatorcontrib><creatorcontrib>Karol, Lori A</creatorcontrib><title>A Longitudinal Review of Gait Following Treatment for Idiopathic Clubfoot: Gait Analysis at 2 and 5 Years of Age</title><title>Journal of pediatric orthopaedics</title><addtitle>J Pediatr Orthop</addtitle><description>BACKGROUND:Initial correction following nonoperative (NonOp) treatment for idiopathic clubfoot has been reported in 95% of feet by age 2; however, by age 4, approximately one third of feet undergo surgery due to relapse. The purpose of this study was to assess the longitudinal effect of growth and surgical (Sx) intervention on gait following NonOp and Sx treatment for clubfoot.
METHODS:Children with idiopathic clubfoot were seen for gait analysis at 2 and 5 years of age. Kinematic data were collected at both visits, and kinetic data were collected at age 5 years. Group comparisons were made between feet treated with the Ponseti casting technique (Ponseti) and the French physical therapy method (PT) and between feet treated nonoperatively and surgically. Comparisons were made between feet treated with a limited release or tendon transfer (fair) and those treated with a full posteromedial release (poor). The α was set to 0.05 for all statistical analyses.
RESULTS:Gait data from 181 children with 276 idiopathic clubfeet were collected at both age 2 and 5 years. Each foot was initially treated with either the Ponseti (n=132) or PT (n=144) method but by the 5-year visit, 30 Ponseti and 61 PT feet required surgery. Gait outcomes showed limitations primarily in the Sx clubfeet. Normal ankle motion was only present in 17% of Ponseti and 21% of PT feet by age 5 following Sx management. Sx PT feet showed persistent intoeing at age 2 and 5. Within the Sx group, feet initially treated with PT had a clinically significant reduction in ankle power compared with those treated initially by the Ponseti method. Feet treated with posteromedial releases had significantly less ankle power than those treated with limited surgery or that remained NonOp at 5 years.
CONCLUSIONS:This longitudinal study shows subtle changes between 2 and 5 years, and continues to support a NonOp approach in the treatment of clubfoot.
LEVEL OF EVIDENCE:Level II—therapeutic.</description><subject>Arthrometry, Articular - methods</subject><subject>Child, Preschool</subject><subject>Clubfoot - diagnosis</subject><subject>Clubfoot - surgery</subject><subject>Clubfoot - therapy</subject><subject>Female</subject><subject>Gait</subject><subject>Humans</subject><subject>Long Term Adverse Effects - diagnosis</subject><subject>Long Term Adverse Effects - physiopathology</subject><subject>Long Term Adverse Effects - surgery</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Manipulation, Orthopedic - adverse effects</subject><subject>Manipulation, Orthopedic - methods</subject><subject>Manipulation, Orthopedic - statistics & numerical data</subject><subject>Orthopedic Procedures - methods</subject><subject>Orthopedic Procedures - statistics & numerical data</subject><subject>Outcome and Process Assessment (Health Care)</subject><subject>Prospective Studies</subject><subject>Range of Motion, Articular</subject><subject>Recurrence</subject><subject>Texas</subject><issn>0271-6798</issn><issn>1539-2570</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEFLwzAYhoMobk7_gUiOXjqTplkab3O4KQwU0YOnkjZft2jWzCR1-O-tbIp4MHyQy_s-H9-D0CklQ0qkuLi6vxuS349Tvof6lDOZpFyQfdQnqaDJSMi8h45CeCGECpaxQ9RLucw5E2kfrcd47pqFia02jbL4Ad4NbLCr8UyZiKfOWrcxzQI_elBxBU3EtfP4Vhu3VnFpKjyxbVk7Fy-3jXFH-QgmYBVxilWjMcfPoHz4Yo4XcIwOamUDnOz-AXqaXj9ObpL53ex2Mp4nFeMjnpSyLHmeaqKkVEzoUUVZLYkCIUheSQY8KzPSHaiZLjXoERdS0TqjWV6VLBNsgM633LV3by2EWKxMqMBa1YBrQ0FzSlNJWDcDlG2jlXcheKiLtTcr5T8KSoov10Xnuvjruqud7Ta05Qr0T-lbbhfIt4GNsxF8eLXtBnyxBGXj8n_2J_lZiYU</recordid><startdate>201609</startdate><enddate>201609</enddate><creator>Jeans, Kelly A</creator><creator>Erdman, Ashley L</creator><creator>Jo, Chan-Hee</creator><creator>Karol, Lori A</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201609</creationdate><title>A Longitudinal Review of Gait Following Treatment for Idiopathic Clubfoot: Gait Analysis at 2 and 5 Years of Age</title><author>Jeans, Kelly A ; Erdman, Ashley L ; Jo, Chan-Hee ; Karol, Lori A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3565-b9bb582d0a99a37d6c13f90ae7708c93e54b40027d3dbded6579a1f4148cb3473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Arthrometry, Articular - methods</topic><topic>Child, Preschool</topic><topic>Clubfoot - diagnosis</topic><topic>Clubfoot - surgery</topic><topic>Clubfoot - therapy</topic><topic>Female</topic><topic>Gait</topic><topic>Humans</topic><topic>Long Term Adverse Effects - diagnosis</topic><topic>Long Term Adverse Effects - physiopathology</topic><topic>Long Term Adverse Effects - surgery</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Manipulation, Orthopedic - adverse effects</topic><topic>Manipulation, Orthopedic - methods</topic><topic>Manipulation, Orthopedic - statistics & numerical data</topic><topic>Orthopedic Procedures - methods</topic><topic>Orthopedic Procedures - statistics & numerical data</topic><topic>Outcome and Process Assessment (Health Care)</topic><topic>Prospective Studies</topic><topic>Range of Motion, Articular</topic><topic>Recurrence</topic><topic>Texas</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jeans, Kelly A</creatorcontrib><creatorcontrib>Erdman, Ashley L</creatorcontrib><creatorcontrib>Jo, Chan-Hee</creatorcontrib><creatorcontrib>Karol, Lori A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric orthopaedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jeans, Kelly A</au><au>Erdman, Ashley L</au><au>Jo, Chan-Hee</au><au>Karol, Lori A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Longitudinal Review of Gait Following Treatment for Idiopathic Clubfoot: Gait Analysis at 2 and 5 Years of Age</atitle><jtitle>Journal of pediatric orthopaedics</jtitle><addtitle>J Pediatr Orthop</addtitle><date>2016-09</date><risdate>2016</risdate><volume>36</volume><issue>6</issue><spage>565</spage><epage>571</epage><pages>565-571</pages><issn>0271-6798</issn><eissn>1539-2570</eissn><abstract>BACKGROUND:Initial correction following nonoperative (NonOp) treatment for idiopathic clubfoot has been reported in 95% of feet by age 2; however, by age 4, approximately one third of feet undergo surgery due to relapse. The purpose of this study was to assess the longitudinal effect of growth and surgical (Sx) intervention on gait following NonOp and Sx treatment for clubfoot.
METHODS:Children with idiopathic clubfoot were seen for gait analysis at 2 and 5 years of age. Kinematic data were collected at both visits, and kinetic data were collected at age 5 years. Group comparisons were made between feet treated with the Ponseti casting technique (Ponseti) and the French physical therapy method (PT) and between feet treated nonoperatively and surgically. Comparisons were made between feet treated with a limited release or tendon transfer (fair) and those treated with a full posteromedial release (poor). The α was set to 0.05 for all statistical analyses.
RESULTS:Gait data from 181 children with 276 idiopathic clubfeet were collected at both age 2 and 5 years. Each foot was initially treated with either the Ponseti (n=132) or PT (n=144) method but by the 5-year visit, 30 Ponseti and 61 PT feet required surgery. Gait outcomes showed limitations primarily in the Sx clubfeet. Normal ankle motion was only present in 17% of Ponseti and 21% of PT feet by age 5 following Sx management. Sx PT feet showed persistent intoeing at age 2 and 5. Within the Sx group, feet initially treated with PT had a clinically significant reduction in ankle power compared with those treated initially by the Ponseti method. Feet treated with posteromedial releases had significantly less ankle power than those treated with limited surgery or that remained NonOp at 5 years.
CONCLUSIONS:This longitudinal study shows subtle changes between 2 and 5 years, and continues to support a NonOp approach in the treatment of clubfoot.
LEVEL OF EVIDENCE:Level II—therapeutic.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>25985372</pmid><doi>10.1097/BPO.0000000000000515</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; Journals@Ovid Ovid Autoload |
| subjects | Arthrometry, Articular - methods Child, Preschool Clubfoot - diagnosis Clubfoot - surgery Clubfoot - therapy Female Gait Humans Long Term Adverse Effects - diagnosis Long Term Adverse Effects - physiopathology Long Term Adverse Effects - surgery Longitudinal Studies Male Manipulation, Orthopedic - adverse effects Manipulation, Orthopedic - methods Manipulation, Orthopedic - statistics & numerical data Orthopedic Procedures - methods Orthopedic Procedures - statistics & numerical data Outcome and Process Assessment (Health Care) Prospective Studies Range of Motion, Articular Recurrence Texas |
| title | A Longitudinal Review of Gait Following Treatment for Idiopathic Clubfoot: Gait Analysis at 2 and 5 Years of Age |
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