Prospective Study of Gross Motor Milestones in Children with Severe Idiopathic Clubfoot Treated by Ponseti Method

Purpose Treatment of idiopathic clubfoot (IC) has improved since the introduction of the Ponseti method. However, relapses are still common and primarily related to non-adherence to the brace regime. Our hypothesis was that IC might be more than just a structural deformity. Based on three studies, the aim of this paper was to provide an overview of findings regarding additional challenges within IC. Methods In total, 153 children with IC and 137 control children participated in the studies. The first study assessed gross motor skills in six motor tasks using the Clubfoot Assessment Protocol. The second and third studies surveyed neurodevelopmental difficulties (NDDs) using the Five to Fifteen (FTF) questionnaire and health-related quality of life (HRQoL) using the EuroQol-5D youth. Results A high percentage of gross motor deviations were found in children with IC compared with controls, and those correlated poorly with clubfoot severity and foot movement. Children with IC had a higher prevalence of NDDs on the FTF compared with the control group, including the domains: motor skills, perception and language. One-third of children with IC were defined as at risk of developmental disorders. In this subgroup, parents were less satisfied with the outcome of clubfoot treatment and the children reported worse HRQoL than those without NDDs. Conclusion The findings suggest additional challenges in children with IC, such as NDDs, apparently affecting both clubfoot treatment outcome and HRQoL. Thus, awareness of these challenges could be vital to further optimize treatment and support, for example, with regards to brace adherence. Level of Evidence II - Prognostic study

Download Full-text

Achievement of Gross Motor Milestones in Children With Idiopathic Clubfoot Treated With the Ponseti Method

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0b013e3182670361 ◽

2013 ◽

Vol 33 (1) ◽

pp. 55-58 ◽

Cited By ~ 13

Author(s):

Debra A. Sala ◽

Alice Chu ◽

Wallace B. Lehman ◽

Harold J.P. van Bosse

Keyword(s):

Ponseti Method ◽

Idiopathic Clubfoot ◽

Gross Motor

Download Full-text

Clinico-sonographical evaluation of idiopathic clubfoot and its correction by Ponseti method — A prospective study

The Foot ◽

10.1016/j.foot.2017.09.005 ◽

2017 ◽

Vol 33 ◽

pp. 7-13 ◽

Cited By ~ 1

Author(s):

Sumit Chawla ◽

Mallika Gupta ◽

Varun Pandey ◽

Abhishek Jain ◽

Manoj Kumar

Keyword(s):

Prospective Study ◽

Ponseti Method ◽

Idiopathic Clubfoot ◽

A Prospective Study

Download Full-text

Standing and walking age in children with idiopathic clubfoot: French physiotherapy versus Ponseti method

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.190097 ◽

2019 ◽

Vol 13 (5) ◽

pp. 471-477

Author(s):

A. Zanardi ◽

V. Fortini ◽

C. N. Abati ◽

C. Bettuzzi ◽

G. Salvatori ◽

...

Keyword(s):

Motor Development ◽

Physical Therapists ◽

Normal Population ◽

Ponseti Method ◽

Idiopathic Clubfoot ◽

Level Of Evidence ◽

Gross Motor ◽

Significant Difference ◽

Walking Age ◽

Independent Ambulation

Purpose A mild delay in gross motor milestones and walking age has been reported in infants with clubfoot. The influence of different treatments on motor development has been poorly investigated. Some parents and physical therapists express concern that the Ponseti method (PM) and its constraints (abduction brace, casts) would affect development more than the French physical therapy method (FM) due to greater immobilization and lesser stimulation. The purpose of this study was to evaluate achievement of three motor milestones (pull-to-standing, cruising and independent walking) in two groups of clubfoot patients treated at two experienced institutes respectively with the PM and FM. Methods In all, 52 consecutive infants (full-term at birth, mean age at beginning of treatment 24.3 days (sd 10), mean Dimeglio score 12 (sd 3.4)) were prospectively enrolled (26 patients per centre) and followed up to walking age recording milestones. Results The two groups were not different in terms of age at the beginning of treatment (p = 0.067) and rate of tenotomy. Age at tenotomy was significantly lower in the PM group (p = 0.000). Severity (p = 0.004) and number of bilateral cases (p = 0.012) were higher in the PM group. A non-significant difference was found for age of achievement of pull-to-standing (p = 0.109), cruising (p = 0.253) and independent ambulation (p = 0.349) between the two groups. Overall, milestones were achieved approximately two months later than normal population. Sex, severity, laterality and need of tenotomy were not found to significantly influence milestones. Conclusion Our results confirmed that infants with clubfoot are expected to have a minimum delay in motor development. Infants treated with the PM and those treated with the FM did not show significant differences in gross motor milestones achievement at walking age. Level of Evidence Level II – Prospective comparative therapeutic studies

Download Full-text

The significance of foot length at the initiation of the Ponseti method: a prospective study

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.190075 ◽

2019 ◽

Vol 13 (3) ◽

pp. 252-257 ◽

Cited By ~ 2

Author(s):

Y. Hemo ◽

A. Yavor ◽

R. Gigi ◽

S. Wientroub

Keyword(s):

Prospective Study ◽

Ponseti Method ◽

Functional Score ◽

Idiopathic Clubfoot ◽

Level Of Evidence ◽

Results Of Treatment ◽

Foot Length ◽

Pirani Score ◽

Additional Surgery ◽

A Prospective Study

Objectives We sought to evaluate foot length (FL) and forefoot circumference (FC) and their impact on the severity of idiopathic clubfoot (CF) and results of treatment. We hypothesized that a smaller foot size at birth that represents a lesser than term newborn may affect the response of the CF to the treatment. Methods We conducted a prospective study documenting FL and FC of all neonates presented with idiopathic CF. Additional demographic information was collected. Outcome measures were number of casts needed for correction, need for recasting, additional surgery and functional score. Results In all, 52 children with 73 CF with a minimum mean follow-up of two years (2.0 to 5.6; sd 1.08) were evaluated. Mean gestational age was 38.63 weeks and mean birth weight (BW) was 3184 g. The mean FL at presentation was 74 mm (5.70 to 9.00), initial Pirani score was 5.5 (2.5 to 6.0) while number of casts was 6.9 (4.0 to 11.0). The FL was significantly correlated both to initial Pirani score (r = -0.35; p < 0.01) and number of casts (r = -0.33; p < 0.05). Positive correlation was found between the number of casts to Pirani score and number of additional procedures (r = 0.39; r = 0.36; p < 0.01, respectively). A foot size of up to 8 cm, needed 7.3 casts (4 to 7) compared with a FL of 8 cm or longer who needed 4.7 casts (4 to 6; t = 7.11; p < 0.001). Conclusion FL is a simple approach to identify preterm babies. It can be used as part of the initial evaluation of CF and help in predicting the course of treatment. We recommend adding FL to the existing classification. Level of Evidence I - Prognostic study

Download Full-text

A Longitudinal Study of Motor and Cognitive Development in Infants With Congenital Idiopathic Clubfoot

Journal of Motor Learning and Development ◽

10.1123/jmld.2016-0077 ◽

2018 ◽

Vol 6 (s1) ◽

pp. S24-S43 ◽

Cited By ~ 1

Author(s):

Julia Dillmann ◽

Christian-Dominik Peterlein ◽

Gudrun Schwarzer

Keyword(s):

Cognitive Development ◽

Cognitive Performance ◽

Motor Development ◽

Cognitive Abilities ◽

Ponseti Method ◽

Fine Motor ◽

Control Group ◽

Idiopathic Clubfoot ◽

Typically Developing ◽

Gross Motor

It was the aim of this study to examine the motor and cognitive development of infants with congenital idiopathic clubfoot, compared with typically developing infants. We repeatedly tested the gross motor, fine motor, and cognitive abilities of 12 infants with clubfoot and 12 typically developing infants at the ages of 4, 6, 9, and 12 months with the Bayley-III Scales. All infants with clubfoot were treated with the Ponseti method, which led to a restriction of normal movements of the lower extremities in the first months of life. They showed a great delay in gross motor development but not in fine motor or cognitive development. However, in the clubfoot group, we found some slight deficits in specific cognitive tasks, including problem solving and spatial memory. In addition, our results revealed significant correlations between gross and fine motor performance and cognitive performance in the control group but only between fine motor and cognitive performance in infants with clubfoot, indicating that both, fine and gross motor skills, are related to cognitive processes and can mutually replace each other to a certain degree. Further research is needed to gain a deeper understanding of clubfoot infants’ development and to clarify the need for mobility training.

Download Full-text

Idiopathic clubfoot treated by Ponseti method: a series of 300 cases

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20184383 ◽

2018 ◽

Vol 4 (6) ◽

pp. 954

Author(s):

Sunil Kumar Bhatiwal ◽

B. L. Chopra ◽

B. L. Khajotia ◽

Shakti Chauhan

Keyword(s):

Prospective Study ◽

Clinical Evaluation ◽

Excellent Result ◽

Ponseti Method ◽

Idiopathic Clubfoot ◽

Congenital Deformities ◽

Pirani Score ◽

The Mean

Background: Clubfoot is a complicated deformity of the foot. It is one of the commonest congenital deformities in children. The main aim of this study was to evaluate the efficacy management of clubfoot by Ponseti method.Methods: This prospective study included 300 children (456 club feet) below the age of 2 years with idiopathic clubfeet from January 2013 to December 2017. In all the cases the Ponseti method was used for the management. The severity of the deformity was assessed with the help of the Pirani score and clinical evaluation of the foot was done.Results: Out of 300 patients 204 patients were male and 96 patients were female and 144 were unilateral clubfoot and 156 were bilateral cases of clubfoot. The mean number of casts required for correction was 5.4 (4–10). Out of 456 clubfeet 356 (78%) feet were required tenotomy. There was relapse seen in 36 (7.9%) feet which had to be managed with 2–3 serial manipulations and casting and these resolved. Excellent result found in our study in 92% cases, good results were found in 5% cases and poor results were found in 3% cases.Conclusions: Ponseti technique is a very useful and effective method of management of idiopathic clubfoot up to 2 year of age.

Download Full-text