Esbjörnsson A-C1, Manusaki E1, Mattsson L2, Andriesse H1
1Lunds University, Department of Clinical Sciences, Orthopedics, Lund, Sweden, 2Prophysics SOL, n.a, Höör, Sweden
Background: Clubfoot is a complex foot deformity that affects the child's entire gait pattern and requires long-term follow-up. Increased gait deviations together with decreased range of motion in the foot are cardinal signs of relapse. Early relapse detection may prevent the need for future surgical corrections. Therefore, objective, sensitive, and easy-to-use assessments of gait quality during follow-up are of importance. However, to our knowledge, no previous study has evaluated the relationship between gait deviations assessed visually according to a structured protocol in a clinical setting and degree of gait deviation measured through three-dimensional (3D) gait analysis.
Purpose: This cross-sectional study evaluates the relationship between gait deviations as measured visually in clinical setting and by 3D instrumented gait analysis in children with idiopathic clubfoot.
Methods: Twenty children treated for clubfoot, consecutively born between 2001 and 2005 participated in this study. Ten children had bilateral and ten had unilateral clubfoot. At seven years of age, the children were referred to 3D gait analysis and, on the same day, also underwent a clinical examination according to the Clubfoot Assessment Protocol (CAP). The CAP is a multilevel observer-administered test that includes assessments of body structure, function, and activity level on a five point scale. Gait related aspects of the CAP, the item walking, passive range of motion (domain mobility) and foot position in loading (domain morphology) were included. The children's overall gait deviations were expressed as the Gait Profile score (GPS) and the Gait Variable Score (GVS). The GPS is a generic index, generated from kinematic 3D gait analysis data. The GPS summarize overall deviation from the pelvis, hip, knee and ankle from sagittal, frontal and transversal planes. The GPS can be decomposed into Gait Variable Scores (GVSs) that represent each of the nine kinematic variables included in the GPS. The correlations between the GPS (both sides and affected side), GVS and gait and foot related aspects of the CAP were analyzed using the Spearman correlation coefficient (rs).
Results: The CAP item “walking” correlated significantly with the GPS (both sides: rs = -0.41, affected side: rs = -0.51), GVS for foot progression (rs = -0.50) and foot dorsiflexion/plantarflexion (rs = -0.47). The domain “morphology” correlated with the GPS (rs = 0.49). The domain “mobility” showed no correlation with 3D gait analysis.
Conclusion(s): These findings indicate that gait deviations clinically observed in children with clubfoot correlate to gait deviations assessed by 3-D gait analysis. This study do not test the stability of these correlations over time nor after surgical intervention, which remains to be done.
Implications: Clinically assessed dynamic measures such as gait quality and foot position in standing showed greater correlation to 3D gait analysis data than measures of passive range of motion. This implies that structured clinical protocols including multiple aspects of function are useful and should be used in clinical setting.
Keywords: Idiopathic clubfoot, gait
Funding acknowledgements: The study was supported by grants from the Faculty of Medicine, Lund University and Region Skåne
Purpose: This cross-sectional study evaluates the relationship between gait deviations as measured visually in clinical setting and by 3D instrumented gait analysis in children with idiopathic clubfoot.
Methods: Twenty children treated for clubfoot, consecutively born between 2001 and 2005 participated in this study. Ten children had bilateral and ten had unilateral clubfoot. At seven years of age, the children were referred to 3D gait analysis and, on the same day, also underwent a clinical examination according to the Clubfoot Assessment Protocol (CAP). The CAP is a multilevel observer-administered test that includes assessments of body structure, function, and activity level on a five point scale. Gait related aspects of the CAP, the item walking, passive range of motion (domain mobility) and foot position in loading (domain morphology) were included. The children's overall gait deviations were expressed as the Gait Profile score (GPS) and the Gait Variable Score (GVS). The GPS is a generic index, generated from kinematic 3D gait analysis data. The GPS summarize overall deviation from the pelvis, hip, knee and ankle from sagittal, frontal and transversal planes. The GPS can be decomposed into Gait Variable Scores (GVSs) that represent each of the nine kinematic variables included in the GPS. The correlations between the GPS (both sides and affected side), GVS and gait and foot related aspects of the CAP were analyzed using the Spearman correlation coefficient (rs).
Results: The CAP item “walking” correlated significantly with the GPS (both sides: rs = -0.41, affected side: rs = -0.51), GVS for foot progression (rs = -0.50) and foot dorsiflexion/plantarflexion (rs = -0.47). The domain “morphology” correlated with the GPS (rs = 0.49). The domain “mobility” showed no correlation with 3D gait analysis.
Conclusion(s): These findings indicate that gait deviations clinically observed in children with clubfoot correlate to gait deviations assessed by 3-D gait analysis. This study do not test the stability of these correlations over time nor after surgical intervention, which remains to be done.
Implications: Clinically assessed dynamic measures such as gait quality and foot position in standing showed greater correlation to 3D gait analysis data than measures of passive range of motion. This implies that structured clinical protocols including multiple aspects of function are useful and should be used in clinical setting.
Keywords: Idiopathic clubfoot, gait
Funding acknowledgements: The study was supported by grants from the Faculty of Medicine, Lund University and Region Skåne
Topic: Paediatrics; Musculoskeletal: lower limb; Disability & rehabilitation
Ethics approval required: Yes
Institution: Lunds University
Ethics committee: Regional Ethical Review Board in Lund
Ethics number: LU-667-03
All authors, affiliations and abstracts have been published as submitted.
