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. 2019 Jun 1;13(3):245-251.
doi: 10.1302/1863-2548.13.190076.

Additional challenges in children with idiopathic clubfoot: is it just the foot?

E Lööf  1   2
Affiliations

Additional challenges in children with idiopathic clubfoot: is it just the foot?

E Lööf. J Child Orthop. .

Abstract

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.

Keywords: clubfoot; gross motor skills; health-related quality of life; neurodevelopmental difficulties; treatment outcome.

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Figures

Fig. 1
Fig. 1
Mean profiles of children with idiopathic clubfoot and the control group on the Five to Fifteen (FTF) questionnaire. Higher numbers indicate greater difficulties. Significant differences were found between the two groups on the total FTF as well as the domains with * (p < 0.05). The figure has been slightly modified from the original figure.
Fig. 2
Fig. 2
The percentage of reported problems (some or a lot of problems) on the EuroQol-5D-youth of the children with idiopathic clubfoot (IC) with and without neurodevelopmental difficulties (NDDs) and the control group; * indicates significant differences between the three groups (p < 0.05). The figure has been modified from the original figure.
See this image and copyright information in PMC

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