Gait analysis of children treated for moderate clubfoot with physical therapy versus the Ponseti cast technique

BACKGROUND: Nonoperative methods for clubfoot treatment include the Ponseti technique and French functional method. The purpose of this study was to compare the gait of children presenting with moderate clubfeet who were treated successfully with these techniques. We hypothesized: (1) no difference in gait parameters of moderate clubfeet treated with either of these nonsurgical techniques and (2) gait parameters after treatment for less severe feet would more closely approximate normal gait. METHODS: Patients whose clubfeet were initially scored between 6 and <10 on the Dimeglio scale underwent gait analysis at the age of 2 years. Kinematic evaluation of the ankle was analyzed and kinematic data were classified as abnormal if more than 1 standard deviation from age-matched normal data. Spearman nonparametric correlation coefficients were used to analyze combined data of moderate to very severe clubfeet to determine any relationship between initial severity and gait outcomes. RESULTS: Gait analysis was performed on 33 patients with 40 moderate clubfeet [17 Ponseti, 23 French physical therapy (PT) feet]. Three Ponseti feet were excluded because they had undergone surgery. No statistically significant differences existed in ankle equinus, dorsiflexion, or push-off plantarflexion between the groups. Swing phase foot drop was present in 6 PT feet (26%) compared with zero Ponseti feet (P=0.026). Normal kinematic ankle motion was present more often in the Ponseti group (82%) than PT (48%) (P=0.027). Regardless of treatment, residual intoeing was seen in one-third of children with moderate clubfeet. The combined group of moderate and severe clubfeet showed no correlation between initial Dimeglio score and presence of normal ankle motion or normal gait at 2 years-of-age. CONCLUSIONS: Normal ankle motion was documented more frequently in the Ponseti feet compared with the PT group. Recent implementation of early tendo-achilles release in PT feet may change these outcomes in the future. In conclusion, gait in children with moderate clubfeet is similar to those in patients with severe clubfeet, but the likelihood of surgery may be less. LEVEL OF EVIDENCE: Therapeutic level II.