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A comparative study of pedobarography and ankle kinematics between children with idiopathic clubfoot after a soft tissue release procedure and controls

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Abstract

Purpose

Surgery for idiopathic clubfoot, though limited in indications, should be performed by a selective soft tissue release. Aims of the study were to evaluate the pedobarography and ankle kinematics of the clubfoot post-surgery and compare with controls.

Methods

Twenty-two patients (33 clubfeet) and 22 normal children (44 feet) were enrolled into the cross-sectional study. Demographic data were recorded. Plantar force measurements and ankle kinematic data were obtained and compared between clubfoot patients and controls by pedobarography and 3-dimensional gait analysis.

Results

Clubfoot patients were operated at an average age of 12.8 ± 8.1 months. The average follow-up was 9.9 ± 3.9 years. Demographic data were comparable between the two groups. The plantar force in clubfoot patients was significantly lower than controls (108.2 ± 86.7 vs. 150.9 ± 73.9 N, p = 0.03). Clubfoot patients demonstrated a longer contact time, larger contact area, lower peak pressure, and force relative to body weight in toe, midfoot, and heel areas. The impulse was comparable between the two groups but the contact area, force, and force time integral concentrated at the midfoot region of the clubfoot. The ankle kinematics in clubfoot patients demonstrated a dorsiflexed position through late toe off. Range of dorsiflexion in the clubfoot was significantly higher than in controls. Foot adduction during stance, limited inversion-eversion, and limited plantar flexion during loading response and toe off were observed.

Conclusion

The results underscore the importance of limited soft tissue release during clubfoot surgery. Although the procedure could preserve range of motion at the ankle joint, muscle weakness and flatfoot deformity are prevalent.

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Acknowledgments

We thank Mr. Kittigon Seehaboot and the staffs of Excellence Center for Gait and Motion, King Chulalongkorn Memorial Hospital for technical assistance and Mr. Paul Hatton for assistance with English language editing.

Funding

This study was supported by a grant from the Ratchadapiseksomphot Fund, Faculty of Medicine, Chulalongkorn University (RA 61/102).

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Authors and Affiliations

  1. Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand

    Noppachart Limpaphayom, Tanteera Tooptakong & Phatcharapa Osateerakun

  2. Bangbuathong Hospital, Ministry of Public Health, Nonthaburi, 11110, Thailand

    Tanteera Tooptakong

  3. Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand

    Phatcharapa Osateerakun

Authors
  1. Noppachart Limpaphayom
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  2. Tanteera Tooptakong
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  3. Phatcharapa Osateerakun
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Correspondence to Noppachart Limpaphayom.

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All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board of Faculty of Medicine, Chulalongkorn University, COA 455/2018 and with the 1964 Helsinki declaration and its later amendments.

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Limpaphayom, N., Tooptakong, T. & Osateerakun, P. A comparative study of pedobarography and ankle kinematics between children with idiopathic clubfoot after a soft tissue release procedure and controls. International Orthopaedics (SICOT) 44, 319–327 (2020). https://doi.org/10.1007/s00264-019-04447-2

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  • DOI: https://doi.org/10.1007/s00264-019-04447-2

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