Gait analysis after initial nonoperative treatment for clubfeet: intermediate term followup at age 5

Abstract

We conducted gait analysis following initial nonoperative clubfoot treatment to compare lower extremity kinematic (eg, ankle motion) and kinetic (eg, ankle power) characteristics between patients treated as infants with Ponseti casting or French physical therapy. This is a followup report of gait characteristics at age 5 years in patients who had previously been tested at age 2 years. One hundred-twenty five clubfeet in 90 patients (34 feet only Ponseti treatment, 40 only French PT, and 51 feet initial nonoperative treatment followed by surgery) were included. The gait characteristics were compared to those of age-matched normal control subjects. Ankle equinus during gait occurred in 5% of feet treated with the French method and none of those treated by the Ponseti method. Increased stance phase ankle dorsiflexion persisted in 24% of feet treated by the Ponseti method. Intoeing was seen in 1/3 of both the French and Ponseti methods. Ankle push-off power was decreased compared to normal in patients treated by both methods, and even more so in operated feet. The presence or absence of Achilles tenotomy did not affect ankle power. Gait characteristics of feet that did not have surgery and maintained correction were superior to those of operated feet.

Fig. 1

Averaged sagittal plane ankle motions for Ponseti (solid), French (dotted) and surgical (dashed) treated clubfeet at 5 years of age were compared to age-matched controls (thick grey band). Positive values are dorsiflexion (DF) and negative values are plantarflexion (PF). Average motions of all three clubfoot groups fall within normal range for ankle motion during gait.

Fig. 2

Averaged sagittal plane ankle power for Ponseti (solid), French (dotted) and surgical (dashed) treated clubfeet at 5 years of age were compared to age-matched controls (thick grey band). Positive values are power generation (Gen) and negative values are power absorption (Abs). All three clubfoot groups are at the lower limit of normal for mean push-off power generation during gait.

Fig. 3

Averaged sagittal plane hip power for Ponseti (solid), French (dotted) and surgical (dashed) treated clubfeet at 5 years of age were compared to age-matched controls (thick grey band). Positive values are power generation (Gen) and negative values are power absorption (Abs). Hip power generation at terminal stance and early swing (vertical line at mid-gait cycle) is at the upper limit of normal for all three clubfoot groups.