Article

Relapse after successful initial correction of idiopathic clubfoot with the
Ponseti method is often related to poor compliance with the foot abduction
orthosis (FAO). The aim of this study was to evaluate treatment with custom-made
dynamic orthoses. Twenty children with idiopathic clubfoot (30feet) who had been
treated with dynamic orthoses after the correction phase according to the Ponseti
casting technique were evaluated. Relapse rates during orthotic treatment were
registered. A Vicon gait analysis system was used to measure gait parameters at
the age of seven years. The overall gait quality was estimated with the Gait
Deviation Index (GDI). Data were analyzed with a nested mixed model and compared
with a control group of 16 healthy children. No relapse occurred during the
orthotic treatment. High compliance with the orthoses was observed based on
parents' self report and physiotherapist observations. Gait analysis showed
decreased ankle power and moment, increased internal foot progression, decreased
dorsiflexion during stance, and increased plantar flexion at initial contact
compared with the control group. Hip and shank rotations were normal. No
calcaneus or equinus gait was observed. The mean GDI was 89.7 (range 71.6-104).
The gait analysis outcomes and frequency of relapse were comparable to those of
previous studies. Internal foot progression originated primarily from the foot
level and was not, as frequently found after FAO treatment, compensated by
external rotation at knee or hip level. In children exhibiting poor compliance
with an FAO, this dynamic model is considered an effective alternative.
CI - Copyright (c) 2016 Elsevier B.V. All rights reserved.

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