title: Achievement of gross motor milestones in children with idiopathic clubfoot treated with the Ponseti method.
abstract: BACKGROUND
  The Ponseti method of idiopathic clubfoot treatment involves a series of weekly casts, a percutaneous Achilles tenotomy if needed, followed by wearing a foot abduction orthosis (FAO). Gross motor development of children with idiopathic clubfoot has not been examined. The purposes of this study were to determine the ages of achievement of gross motor milestones in children with clubfoot treated with Ponseti method and to compare those ages with historical normative developmental data.
  
  
  METHODS
  In this prospective study, 51 children with idiopathic clubfoot who had their first cast applied when ≤90 days old, were full-term with no other orthopaedic conditions or previous clubfoot treatment, and were compliant with wearing FAO were enrolled. Parents were interviewed repeatedly to acquire the ages of achievement of 8 gross motor milestones.
  
  
  RESULTS
  Fifteen children were excluded for reasons such as noncompliance with FAO, and not returning for follow-up. Thirty-six children, mean age of 15.2 days at first casting, achieved rolling prone to supine at a mean age of 5.1 months, rolling supine to prone at 5.1 months, sitting without support at 6.6 months, crawling on stomach at 7.1 months, crawling on hands and knees at 8.6 months, pull-to-stand at 9.0 months, cruising at 10.2 months, and ambulating independently at 13.9 months. When compared with previously published values for unaffected children, the mean ages of achievement for 6 of 8 milestones were significantly greater (P<0.05) for the children with clubfoot. The preambulatory milestones were achieved from 0.7 to 1.5 months later and independent ambulation up to 2.2 months later. Fifty percent of children with clubfoot were ambulating at 13.8 months; 90% at 17.7 months.
  
  
  CONCLUSIONS
  Minimal delays in gross motor milestone achievement were found in children with idiopathic clubfoot treated with the Ponseti method. Delays were, at most, 1.5 months, except for independent ambulation, which was approximately 2 months. These findings should enable pediatric clinicians to alleviate the concerns of parents of children with idiopathic clubfoot regarding gross motor milestone achievement.
  
  
  METHODS
  Therapeutic Level II.
authors.affiliation: New York Ponseti Clubfoot Center, Pediatric Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY 10003, USA. debra.sala@nyumc.org
authors.forename: Debra A
authors.initials: DA
authors.lastname: Sala
authors.forename: Alice
authors.initials: A
authors.lastname: Chu
authors.forename: Wallace B
authors.initials: WB
authors.lastname: Lehman
authors.forename: Harold J P
authors.initials: HJ
authors.lastname: van Bosse
mesh_terms: D000367:Age Factors; D002370:Casts, Surgical; D002657:Child Development; D003025:Clubfoot / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009048:Motor Skills; D009989:Orthotic Devices; D011446:Prospective Studies; D058971:Tenotomy; D016896:Treatment Outcome