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Evaluation of a Disease-specific Instrument for Idiopathic Clubfoot Outcome

  • Symposium: Clubfoot: Etiology and Treatment
  • Published:
Clinical Orthopaedics and Related Research


In 2001, Roye et al. developed a disease-specific instrument (DSI) to measure outcomes of treatment for clubfoot. We assessed this instrument using a cohort of 62 patients, ages 5 through 12 years (mean, 8.6 years), with idiopathic clubfoot who were treated as infants by various methods. Treatment groups were defined by whether the patient received joint-invasive surgery (posterior or posteromedial release surgery) or joint-sparing treatment only (manipulation and casting with or without tendo-Achilles lengthening or anterior tibial tendon transfer). The DSI scales demonstrated internal consistency reliability of 0.74 to 0.85 using Cronbach’s alpha. Higher (better) DSI scores were associated with “excellent” general health ratings and better health-related quality of life; lower DSI score were related to special healthcare needs. Patients treated using joint-sparing techniques only (eg, Ponseti technique) had higher DSI scores than those who had received joint-invasive surgery. DSI scores for patients who had received posterior or posterior medial release surgery were very similar to those reported by Roye et al. in New York for a comparable group of patients. Our findings suggest the DSI is sensitive to differences in treatment technique or underlying severity of disease. These data support the use of the Roye DSI as an outcome measure for idiopathic clubfoot in children.

Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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We thank Drs. Roye and Vitale for providing summary data for comparisons. We also thank research interviewers and technical staff of the Center for Social and Behavioral Research at the University of Northern Iowa for their skill, sensitivity, and efficiency in scheduling and conducting the interviews and translating the information into useable data.

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Correspondence to Frederick R. Dietz MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stockownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Dietz, F.R., Tyler, M.C., Leary, K.S. et al. Evaluation of a Disease-specific Instrument for Idiopathic Clubfoot Outcome. Clin Orthop Relat Res 467, 1256–1262 (2009).

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