Plantar pressures following ponseti and french physiotherapy methods for clubfoot

Background: Recent trends have led to interest in nonoperative treatments for clubfoot (Ponseti casting and French Physiotherapy). Current studies show good sagittal kinematic motion after both treatments in the young child, but changes in plantar loading after these treatments have not yet been reported. Methods: Pedobarograph data were collected with the Emed System on 151 clubfeet, treated with either Cast (79 feet) or physiotherapy (PT, 72 feet), at the age of 2 years. Medial and lateral differences in plantar pressures, contact area, and contact time, were assessed in the hindfoot, midfoot, and forefoot. An assessment of forefoot adductus was made, while the center of the pressure line was tracked both medially and laterally. Seventeen controls were used for comparison. Results: When comparing Cast feet with PT feet, most differences in plantar pressures were found in the hindfoot and medial midfoot. Peak pressure, maximum force, and pressure time integral were all found to be decreased in the medial hindfoot after PT compared with casting. Maximum force was also less in the lateral hindfoot and peak pressure was less in the medial midfoot for the PT feet compared with the Cast feet. When compared with controls, both Cast and PT feet had increased pressure, force, contact time, contact area, and pressure time integral in the lateral midfoot, whereas the same measures were all significantly decreased in the first metatarsal region. Forefoot adductus was present in both groups compared with controls. The center of the pressure line was significantly displaced to the lateral side of the foot in both groups; however, when assessing medial displacement, only the PT feet had significantly less medial distribution compared with control feet. Conclusion: Pedobarography illustrates residual pressure differences during gait in children with nonoperatively treated clubfeet. These data provide a more detailed description of dynamic foot loading and residual deformity than sagittal plane kinematics alone. Level of Evidence: Therapeutic Level II.