Berg-Poppe P1, Haft G2, Svien L1, Deering A1, Gebhart B1, Jorgensen H1, Klinkhammer H1
1University of South Dakota, Physical Therapy, Vermillion, United States, 2Sanford Health Systems, Pediatrics - Orthopedic Surgery, Sioux Falls, United States
Background: Congenital Talipes Equinovarus (CTEV), also referred to as “clubfoot,” is a condition of unknown etiology formed in utero. At birth, an infant presents with inversion, adduction, and equinus of the joints of the foot and ankle to varying degrees. The Ponseti method for correction of clubfoot involves serial manipulations and castings followed by a bracing regimen. While the Ponseti method is the treatment of choice for CTEV, when compared to children born with typical feet, children undergoing the method demonstrate less power and flexibility at the foot and ankle, leading to differences in the performance of complex functional activities demanding power and flexibility.
Purpose: The purpose of this research was to examine agility, balance, and functional ballistic performance in children with a history of Ponseti correction for CTEV.
Methods: A cross-sectional analysis was undertaken. Children between the ages of 6.5-12 years old with (CTEV group) and without (Control Group, aka CG) diagnosis participated in a one-time assessment. Agility measures included the Modified T-test and the 10-metre shuttle run. Balance measures included the standing pediatric reach test (PRT). A digitized walkway was used to measure ballistic task performance, including standing broad jump, single leg hop, and triple leg hop distances traveled. The standard protocol for the Sargent jump test was also used. Orthopedic measures included talocrural joint dorsiflexion (DF) strength, plantarflexion (PF) strength (using a heel-rise to fatigue protocol), passive DF, forefoot inversion and eversion, midfoot inversion and eversion, and rear foot subtalar joint inversion and eversion ranges of motion (ROM) as well as closed chain calcaneal eversion and DF ROM. Group differences in agility, balance, and ballistic performance were analyzed using a multivariate analysis of variance. Independent t-tests were used to compare orthopedic measures. Pearson correlation was used to explore whole-sample relationships between orthopedic measures and functional performance.
Results: Participants comprised 32 subjects (CTEV-G = 16; CG = 16). Matched children did not differ in age or BMI. There were no statistically perceivable between-group differences in musculoskeletal measures of strength or passive joint range of motion, with the exception of passive talocrural joint DF (CTEV-G = 18.07+14.12 degrees; CG = 26.94 +9.50). Analysis of agility, balance, and ballistic performance revealed no significant between-group differences. DF strength was strongly correlated with all measures of balance, agility, and 2 of 4 measures of ballistic performance, while PF strength and Passive DF ROM were strongly correlated with vertical jump.
Conclusion(s): While CTEV-G demonstrated poorer agility, balance, and ballistic performance overall, these differences did not meet a level of statistical significance. Ponseti correction alters foot and ankle biomechanics successfully enough than an analysis of performance does not differentiate children with a history of Ponseti treatment for CTEV from peers unaffected by the congenital condition.
Implications: Parents seeking advice about prognosis and outcomes related to their infant's ability to keep up with peers after Ponseti correction for CTEV can be reassured that while deficits in agility, balance, and ballistic control may be present, these deficits are unlikely to significantly impact functional performance in general.
Keywords: Pediatrics, Club Foot, Physiotherapy
Funding acknowledgements: This study has received internal funding from the University of South Dakota´s Department of Physical Therapy.
Purpose: The purpose of this research was to examine agility, balance, and functional ballistic performance in children with a history of Ponseti correction for CTEV.
Methods: A cross-sectional analysis was undertaken. Children between the ages of 6.5-12 years old with (CTEV group) and without (Control Group, aka CG) diagnosis participated in a one-time assessment. Agility measures included the Modified T-test and the 10-metre shuttle run. Balance measures included the standing pediatric reach test (PRT). A digitized walkway was used to measure ballistic task performance, including standing broad jump, single leg hop, and triple leg hop distances traveled. The standard protocol for the Sargent jump test was also used. Orthopedic measures included talocrural joint dorsiflexion (DF) strength, plantarflexion (PF) strength (using a heel-rise to fatigue protocol), passive DF, forefoot inversion and eversion, midfoot inversion and eversion, and rear foot subtalar joint inversion and eversion ranges of motion (ROM) as well as closed chain calcaneal eversion and DF ROM. Group differences in agility, balance, and ballistic performance were analyzed using a multivariate analysis of variance. Independent t-tests were used to compare orthopedic measures. Pearson correlation was used to explore whole-sample relationships between orthopedic measures and functional performance.
Results: Participants comprised 32 subjects (CTEV-G = 16; CG = 16). Matched children did not differ in age or BMI. There were no statistically perceivable between-group differences in musculoskeletal measures of strength or passive joint range of motion, with the exception of passive talocrural joint DF (CTEV-G = 18.07+14.12 degrees; CG = 26.94 +9.50). Analysis of agility, balance, and ballistic performance revealed no significant between-group differences. DF strength was strongly correlated with all measures of balance, agility, and 2 of 4 measures of ballistic performance, while PF strength and Passive DF ROM were strongly correlated with vertical jump.
Conclusion(s): While CTEV-G demonstrated poorer agility, balance, and ballistic performance overall, these differences did not meet a level of statistical significance. Ponseti correction alters foot and ankle biomechanics successfully enough than an analysis of performance does not differentiate children with a history of Ponseti treatment for CTEV from peers unaffected by the congenital condition.
Implications: Parents seeking advice about prognosis and outcomes related to their infant's ability to keep up with peers after Ponseti correction for CTEV can be reassured that while deficits in agility, balance, and ballistic control may be present, these deficits are unlikely to significantly impact functional performance in general.
Keywords: Pediatrics, Club Foot, Physiotherapy
Funding acknowledgements: This study has received internal funding from the University of South Dakota´s Department of Physical Therapy.
Topic: Paediatrics; Orthopaedics; Musculoskeletal: lower limb
Ethics approval required: Yes
Institution: University of South Dakota
Ethics committee: Institutional Review Board (IRB)
Ethics number: 2017177
All authors, affiliations and abstracts have been published as submitted.
