Does idiopathic congenital talipes equinovarus have an impact on attainment of developmental milestones? A multicentre international study

Abstract

Purpose: The Ponseti method is a well-established approach to treating clubfoot. Potentially, both the underlying pathology and adherence to post-correction bracing can affect lower limb function and age of independent standing and walking. This cohort study investigates the age at which infants with idiopathic clubfoot treated using the Ponseti method achieved three selected developmental milestones and whether or not this correlated with treatment compliance.

Methods: A prospectively collected database from four centres was visited. Inclusion criteria were patients with idiopathic clubfoot with no comorbidities or prior treatment. Age at attainment of independent standing, walking, nocturnal continence was compared across three groups: I) congenital talipes equinovarus (CTEV) children compliant with treatment; II) CTEV children non-compliant with treatment; and III) typically-developed siblings. Minimum follow-up was five years.

Results: In all, 130 patients (198 feet) fitted the inclusion criteria: 43:87 (F:M). Standing was achieved by a mean 12.0 months in group I (sd 2.50); 12.0 months (sd 2.0) in II and ten months (sd 3.0) in III. Walking was achieved by a mean 15 months (sd 4.0) in group I, 14 months (sd 1.75) in II and 12 months (sd 3) in III, respectively. Both the compliant and non-compliant CTEV children were significantly slower at achieving standing and walking compared to sibling controls (p < 0.0001). There was no significant difference between age of nocturnal continence between the three groups.

Conclusion: Infants with idiopathic clubfoot treated according to the Ponseti method achieve independent standing and walking approximately two months later than their typically-developed siblings. The delay is not related to the use of the foot abduction brace.

Level of evidence: III.

Keywords: Clubfoot; Ponseti; developmental milestones.

Appendix 1

Flowchart of the patient selection process.

Fig. 1

Standing, walking and nocturnal continence age in congenital talipes equinovarus (CTEV) patients compliant to the foot abduction brace (FAB), CTEV patients non-compliant to the FAB, compared with their typically developed siblings. Bars show median and upper quartile.

Fig. 2

Standing, walking and nocturnal continence age in congenital talipes equinovarus (CTEV) patients compared across all four hospital sites. Bars show mean and standard deviation (SGH, St. George’s Hospital; GOSH, Great Ormond Street Hospital; RSH, Royal Surrey County Hospital; DCH, Dana Children’s Hospital).

Fig. 3

The association between the severity of congenital talipes equinovarus, as measured by a Pirani score, and standing, walking and nocturnal continence ages. Line depicts best fit. Red circles represent children with only one foot affected; blue circles represent children with both feet affected.