Purpose Isolated congenital clubfoot can be treated either
operatively (posteromedial release) or conservatively
(Ponseti method). This study retrospectively compared
mid-term outcomes after surgical and Ponseti treatments to
a normal sample and used multiple evaluation techniques,
such as detailed gait analysis and foot kinematics.
Methods Twenty-six children with clubfoot treated surgically
and 22 children with clubfoot treated with the
Ponseti technique were evaluated retrospectively and
compared to 34 children with normal feet. Comprehensive
evaluation included a full gait analysis with multi-segment
and single-segment foot kinematics, pedobarograph,
physical examination, validated outcome questionnaires,
and radiographic measurements.
Results The Ponseti group had significantly better plantarflexion
and dorsiflexion range of motion during gait and
had greater push-off power. Residual varus was present in
both treatment groups, but more so in the operative group.
Gait analysis also showed that the operative group had
residual in-toeing, which appeared well corrected in the
Ponseti group. Pedobarograph results showed that the
operative group had significantly increased varus and significantly
decreased medial foot pressure. The physical
examination demonstrated significantly greater stiffness in
the operative group in dorsiflexion, plantarflexion, ankle
inversion, and midfoot abduction and adduction. Surveys
showed that the Ponseti group had significantly more
normal pediatric outcome data collection instrument
results, disease-specific indices, and Dimeglio scores. The
radiographic results suggested greater equinus and cavus
and increased foot internal rotation profile in the operative
group compared with the Ponseti group. |
