Conservative and Surgical Clubfoot Treatment: Multi-Center Study
Clubfoot is a congenital foot deformity occurring in 1 in 1,000 births. It is commonly treated at pediatric orthopaedic hospitals and its incidence has been constant and not expected to decrease. Treatment is ideally accomplished early in life, within the first year, and is often successful in accomplishing a satisfactory, plantigrade foot, which will fit in shoes. Little is known, however about the function of treated clubfeet.
This study is designed to compare two methods of clubfoot treatment: 1) the Ponseti technique of manipulation and casting and 2) progressive surgical release. The protocol is designed to improve our understanding of the function of the clubfoot during adolescence/young adulthood, and to allow a comparison with normal foot function. The methods are structured to establish the relationship between patient based outcomes, technical and functional measures. We hope to obtain a better picture of the variability of clubfoot pathology among the treated groups using patient satisfaction and self-perception, outcomes measures and quantitative functional tests.
The proposed work will investigate the longer-term outcome of children with treated clubfoot deformity using patient based outcomes, functional instruments (AOFAS hindfoot and midfoot scores, ICFSG, and PODCI) motion analysis (gait and foot and ankle), radiological assessment and postural stability. Our objective is to determine whether functional outcomes, postural stability and gait analysis characterize overall patient satisfaction and motor performance and to quantify the effects of orthopaedic interventions. As part of this process, we will complete a comparison of objective functional results and outcomes measures. The study population will include children with clubfoot deformity treated fifteen to twenty-two years ago, and an age matched control population.
In order to achieve the study objectives, we will evaluate the correlation among functional instruments (AOFAS, ICSFG, GMFM and PODCI) and quantitative measures. We will use our existing 3-D gait analysis system, foot and ankle assessment system (Milwaukee Foot Model), Biodex III strength system, and Neurocom dynamic postural stability assessment system, to quantify motion (kinematic and kinetic), strength, and dynamic postural stability parameters. We will quantify the correlation among patient perceptions, motion (kinematics, and kinetics), strength and stability parameters, and outcomes measures (AOFAS, ICSFG, and PODCI) in patients with treated clubfoot.
The degree of correlation among these patient based outcomes and functional tools may greatly enhance our assessment capability of treatment intervention. This research should bring insight into methods of evaluating outcomes and function and comparing the effects of different treatments.
Our previous work includes an investigation of clubfoot treatment in 17 patients using the ICFSG and AOFAS outcomes measures and quantitative gait analysis. The study recognized that morphological evaluation does not always correlate with functional capacity and treatment outcome over a long-term follow-up. We also investigated the role of gastrocsoleus strength as a predictor of outcome. Our current project proposes to expand on these findings and those from a large outcomes correlation study of seventy-two children by applying quantitative and functional outcomes instruments to examine clubfoot treatment.
U. S. Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR)
H133G060252
Co-Principal Investigators: Gerald F. Harris, Ph.D., P.E.
1/1/07 – 12/31/09