Children with and without relapsed clubfoot show task-specific deviations in lower limb kinematics during several dynamic activities compared to typically developing children

Abstract

Background

The occurrence and the treatment of a relapsed clubfoot is a challenge in clubfoot care. Early recognition of relapse is important to minimize the invasiveness of treatment and its impact on foot functionality later in life. Gaining insight into a child's functional performance during various challenging activities will provide a comprehensive understanding of treatment outcomes which might result in crucial information for identifying relapse indicators.

Research question

This study aims to identify kinematic differences during dynamic activities between relapsed and non-relapsed Ponseti-treated clubfoot patients, and typically developing children.

Methods

Movement analysis, including the Helen Hayes model extended with the Oxford Foot model, was performed in 56 children; 14 relapsed clubfoot, 21 non-relapsed clubfoot and 21 age-matched TDC. Differences in lower extremity kinematics during walking, toe walking, heel walking and running were analyzed using statistical parametric mapping.

Results

Compared to walking, more demanding activities accentuated task-specific deviations in children with clubfoot, such as limited plantar flexion during toe walking and decreased knee flexion during running. Children with relapsed clubfoot showed kinematic deviations in all three planes of motion across all four activities, compared with children with non-relapsed clubfoot or TDC. Differences are observed at the foot and the pelvis, as well as in the hip and knee joints.

Significance

More demanding dynamic activities aid in distinguishing between relapsed and non-relapsed clubfoot, by revealing task-specific deviations. Furthermore, our findings suggest that clinical assessment of clubfoot should include attention to compensations rather than only focusing on foot-specific characteristics.