title: Evaluation of gait, relapse and compliance in clubfoot treatment with custom-made orthoses.
abstract: Relapse after successful initial correction of idiopathic clubfoot with the Ponseti method is often related to poor compliance with the foot abduction orthosis (FAO). The aim of this study was to evaluate treatment with custom-made dynamic orthoses. Twenty children with idiopathic clubfoot (30feet) who had been treated with dynamic orthoses after the correction phase according to the Ponseti casting technique were evaluated. Relapse rates during orthotic treatment were registered. A Vicon gait analysis system was used to measure gait parameters at the age of seven years. The overall gait quality was estimated with the Gait Deviation Index (GDI). Data were analyzed with a nested mixed model and compared with a control group of 16 healthy children. No relapse occurred during the orthotic treatment. High compliance with the orthoses was observed based on parents' self report and physiotherapist observations. Gait analysis showed decreased ankle power and moment, increased internal foot progression, decreased dorsiflexion during stance, and increased plantar flexion at initial contact compared with the control group. Hip and shank rotations were normal. No calcaneus or equinus gait was observed. The mean GDI was 89.7 (range 71.6-104). The gait analysis outcomes and frequency of relapse were comparable to those of previous studies. Internal foot progression originated primarily from the foot level and was not, as frequently found after FAO treatment, compensated by external rotation at knee or hip level. In children exhibiting poor compliance with an FAO, this dynamic model is considered an effective alternative.
authors.affiliation: Lund University, Department of Clinical Sciences, Lund, Orthopedics, SE 221 85 Lund, Sweden. Electronic address: evgenia.manousaki@med.lu.se.
authors.forename: Evgenia
authors.initials: E
authors.lastname: Manousaki
authors.affiliation: Lund University, Department of Research and Education, Klinikgatan 22, Wigerthuset University Hospital, 221 85 Lund, Sweden. Electronic address: tc@rcsyd.se.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Czuba
authors.affiliation: Lund University, Department of Clinical Sciences, Lund, Orthopedics, SE 221 85 Lund, Sweden. Electronic address: gunnar.hagglund@med.lu.se.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Hägglund
authors.affiliation: Prophysics SOL, SE 243 35, Höör, Sweden. Electronic address: mattsson@prophysics-sol.se.
authors.forename: Louise
authors.initials: L
authors.lastname: Mattsson
authors.affiliation: Lund University, Department of Clinical Sciences, Lund, Orthopedics, SE 221 85 Lund, Sweden. Electronic address: hanneke.andriesse@med.lu.se.
authors.forename: Hanneke
authors.initials: H
authors.lastname: Andriesse
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000843:Ankle Joint; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D061826:Foot Orthoses; D005684:Gait; D006801:Humans; D007223:Infant; D007719:Knee Joint; D008297:Male; D010349:Patient Compliance; D012008:Recurrence; D058971:Tenotomy; D016896:Treatment Outcome
keywords: Clubfoot; Compliance; Gait analysis; Orthosis; Relapse