Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(05): 637-641
DOI: 10.1055/s-0040-1709201
Artigo Original
Pediátrica

Does the Presence of Clubfoot delay the Onset of Walking?

Article in several languages: português | English
Ronan Bertinatto 
1   Departamento de Ortopedia Pediátrica, Hospital Pequeno Príncipe, Curitiba, PR, Brasil
,
Edilson Forlin 
1   Departamento de Ortopedia Pediátrica, Hospital Pequeno Príncipe, Curitiba, PR, Brasil
,
Leonardo Wustro 
1   Departamento de Ortopedia Pediátrica, Hospital Pequeno Príncipe, Curitiba, PR, Brasil
,
Jacqueline Ojeda Tolotti 
1   Departamento de Ortopedia Pediátrica, Hospital Pequeno Príncipe, Curitiba, PR, Brasil
,
Geovanna Andrade Labres de Souza 
2   Departamento de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective Congenital clubfoot (PTC) is a congenital orthopedic condition often requiring intensive treatment; little is known about the impact of such treatment on motor development. The present study assessed whether gait development is later in patients with PTC treated with the Ponseti method in comparison to a control group and analyzed possible related factors.

Methods Patients born at term, < 6 months old, not submitted to previous treatment and with a minimum follow-up period of 24 months were included. The control group consisted of patients with no musculoskeletal disorders seen during the present study.

Results The study group consisted of 97 patients, whereas the control group had 100 subjects. The mean age at gait start was 14.7 ± 3.2 months in the study group and 12.6 ± 1.5 months in the control group (p < 0.05). Factors related to late gait included age at beginning of treatment > 3 weeks, number of plaster cast changes > 7, recurrence and nonperformance of Achilles tenotomy. Age at beginning of treatment > 3 weeks was related to a greater number of plaster cast changes. Gender and laterality were not related to late gait development.

Conclusion Congenital clubfoot patients treated with the Ponseti method show independent walking approximately 2 months later than the control group. Delayed treatment, higher number of plaster cast changes, recurrence and nonperformance of Achilles tenotomy were related to late gait.

Keywords

clubfoot - gait - congenital lower limb deformities - orthopedic manipulation - treatment outcome


Publication History

Received: 24 April 2019

Accepted: 20 January 2020

Article published online:
08 June 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda
Rio de Janeiro, Brazil

 

  • Referências

  • 1 Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am 1992; 74 (03) 448-454
    CrossrefPubMedGoogle Scholar
  • 2 Dobbs MB, Gurnett CA. Update on clubfoot: etiology and treatment. Clin Orthop Relat Res 2009; 467 (05) 1146-1153
    CrossrefPubMedGoogle Scholar
  • 3 Ponseti IV. Congenital clubfoot: fundamentals of treatment. Oxford: Oxford University Press; 1996
    Google Scholar
  • 4 Cummings RJ, Davidson RS, Armstrong PF, Lehman WB. Congenital clubfoot. J Bone Joint Surg Am 2002; 84 (02) 290-308
    CrossrefPubMedGoogle Scholar
  • 5 Herring JB. Congenital talipes equinovarus. In: Tachdjian MO. Tachdjian: pediatric orthopaedics. Philadelphia: Saunders; 2001: 922-959
    Google Scholar
  • 6 Zionts LE, Zhao G, Hitchcock K, Maewal J, Ebramzadeh E. Has the rate of extensive surgery to treat idiopathic clubfoot declined in the United States?. J Bone Joint Surg Am 2010; 92 (04) 882-889
    CrossrefPubMedGoogle Scholar
  • 7 Sizínio HK, Barros Filho TEP, Xavier R, Pardini Júnior A. Ortopedia e traumatologia: princípios e prática. Porto Alegre: Artmed; 2017
    Google Scholar
  • 8 Zionts LE, Sangiorgio SN, Ebramzadeh E, Morcuende JA. The current management of idiopathic clubfoot revisited: results of a survey of the POSNA membership. J Pediatr Orthop 2012; 32 (05) 515-520
    CrossrefPubMedGoogle Scholar
  • 9 Garcia NL, McMulkin ML, Tompkins BJ, Caskey PM, Mader SL, Baird GO. Gross motor development in babies with treated idiopathic clubfoot. Pediatr Phys Ther 2011; 23 (04) 347-352
    CrossrefPubMedGoogle Scholar
  • 10 Sala DA, Chu A, Lehman WB, van Bosse HJ. Achievement of gross motor milestones in children with idiopathic clubfoot treated with the Ponseti method. J Pediatr Orthop 2013; 33 (01) 55-58
    CrossrefPubMedGoogle Scholar
  • 11 Zionts LE, Packer DF, Cooper S, Ebramzadeh E, Sangiorgio S. Walking age of infants with idiopathic clubfoot treated using the ponseti method. J Bone Joint Surg Am 2014; 96 (19) e164
    CrossrefPubMedGoogle Scholar
  • 12 WHO Multicentre Growth Reference Study Group. WHO Motor Development Study: windows of achievement for six gross motor development milestones. Acta Paediatr Suppl 2006; 450: 86-95
    Google Scholar
  • 13 Aulie VS, Halvorsen VB, Brox JI. Motor abilities in 182 children treated for idiopathic clubfoot: a comparison between the traditional and the Ponseti method and controls. J Child Orthop 2018; 12 (04) 383-389
    CrossrefPubMedGoogle Scholar
  • 14 Lööf E, Andriesse H, André M, Böhm S, Iversen MD, Broström EW. Gross motor skills in children with idiopathic clubfoot and the association between gross motor skills, foot involvement, gait, and foot motion. J Pediatr Orthop 2019; 39 (07) 359-365
    CrossrefPubMedGoogle Scholar