title: A comprehensive outcome comparison of surgical and Ponseti clubfoot treatments with reference to pediatric norms.
abstract: OBJECTIVE
  Isolated congenital clubfoot can be treated either operatively (posteromedial release) or conservatively (Ponseti method). This study retrospectively compared mid-term outcomes after surgical and Ponseti treatments to a normal sample and used multiple evaluation techniques, such as detailed gait analysis and foot kinematics.
  
  
  METHODS
  Twenty-six children with clubfoot treated surgically and 22 children with clubfoot treated with the Ponseti technique were evaluated retrospectively and compared to 34 children with normal feet. Comprehensive evaluation included a full gait analysis with multi-segment and single-segment foot kinematics, pedobarograph, physical examination, validated outcome questionnaires, and radiographic measurements.
  
  
  RESULTS
  The Ponseti group had significantly better plantarflexion and dorsiflexion range of motion during gait and had greater push-off power. Residual varus was present in both treatment groups, but more so in the operative group. Gait analysis also showed that the operative group had residual in-toeing, which appeared well corrected in the Ponseti group. Pedobarograph results showed that the operative group had significantly increased varus and significantly decreased medial foot pressure. The physical examination demonstrated significantly greater stiffness in the operative group in dorsiflexion, plantarflexion, ankle inversion, and midfoot abduction and adduction. Surveys showed that the Ponseti group had significantly more normal pediatric outcome data collection instrument results, disease-specific indices, and Dimeglio scores. The radiographic results suggested greater equinus and cavus and increased foot internal rotation profile in the operative group compared with the Ponseti group.
  
  
  CONCLUSIONS
  Ponseti treatment provides superior outcome to posteromedial release surgery, but residual deformity still persists.
authors: Gait Analysis Lab, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 USA.
authors: Chris
authors: C
authors: Church
authors: Julie A
authors: JA
authors: Coplan
authors: Dijana
authors: D
authors: Poljak
authors: Ahmed M
authors: AM
authors: Thabet
authors: Durga
authors: D
authors: Kowtharapu
authors: Nancy
authors: N
authors: Lennon
authors: Stephanie
authors: S
authors: Marchesi
authors: John
authors: J
authors: Henley
authors: Roland
authors: R
authors: Starr
authors: Dan
authors: D
authors: Mason
authors: Mohan V
authors: MV
authors: Belthur
authors: John E
authors: JE
authors: Herzenberg
authors: Freeman
authors: F
authors: Miller
keywords: Clubfoot; Foot; Gait analysis; Kinematics; Pediatrics; Ponseti