Aulie VS1, Halvorsen VB2, Brox JI3
1Oslo University Hospital, Division of Pediatric and Adolescent Medicine, Oslo, Norway, 2Oslo University Hospital, Division of Orthopaedics Surgery, Oslo, Norway, 3Oslo University Hospital, Deparment of Physical Medicine and Rehabiliation, Oslo, Norway
Background: Idiopathic clubfoot is one of the most common birth defects involving the musculoskeletal system with a range of variations. Some researchers have reported signs of a general deficit in motor skills in patients with idiopathic clubfoot, some have found inferiority in gait and some researchers found no difference in coping with physical activity compared to healthy peers. Only a few studies have evaluated motor ability or skills, and studies compared motor outcomes in two different treatment strategies for schoolchildren with clubfoot are rare.
Purpose: The aim of the study was to examine and compare motor abilities in children treated for idiopathic clubfoot with either the traditional extensive surgery method or the Ponseti method.
Methods: The children were all assessed with the Movement Assessment Battery for Children (MABC-2). It evaluates motor performance according to hand function, ball skills and balance, static and dynamic. The MABC-2 age band 7-10 years was used in this study. MABC-2-scores can be used to identify children who are behind their peers in motor development. All the children were tested by the same physiotherapist specialized in the field. The children were recruited from a Norwegian multicenter clubfoot study and healthy age-matched individuals were recruited from a school nearby the hospital.
Results: Eighty-nine children treated according to the traditional method (mean age 9.0 years, 7 to 10) and 93 treated a.m. Ponseti (mean age 8.8 years, 7 to 10) and 45 age matched healthy individuals were assessed. The children treated a.m. Ponseti, had serial castings (3-13 casts) starting a few days after birth. Eighty-four % of them had Achillotomy after an average of 7 castings. They had abduction braces for four years thereafter. The exact compliance concerning the recommended use of the brace is difficult to state. The number who had achillotomy was higher in the Ponseti group and the number of major operations was higher in the traditional group ( 0.001). In the control group 96 % had normal motor function, and 4 % had motor problems. In the Ponseti group 76 % had normal motor function, 9 % was categorized as having clumsiness and 14 % had motor problems, in the traditional group 76% had normal motor function, 6 % having clumsiness and 17% had motor problems. We found no difference in motor scores whether the children had undergone surgery more than the initial Achillotomy or not. The subgroups are small and one should be cautious interpreting the data.
Conclusion(s): About one- quarters of children with idiopathic clubfeet have inferior motor function compared with their peers tested in early school age according to MABC-2. Some have motor problems that might qualify for physiotherapeutic follow-up.
Implications: This study indicates that a closer follow-up concerning motor skills should be considered for patients with idiopathic clubfoot in pre-school age.
Keywords: Clubfeet;, Ponseti;, motor abilities
Funding acknowledgements: Sophies Minde Foundation
Purpose: The aim of the study was to examine and compare motor abilities in children treated for idiopathic clubfoot with either the traditional extensive surgery method or the Ponseti method.
Methods: The children were all assessed with the Movement Assessment Battery for Children (MABC-2). It evaluates motor performance according to hand function, ball skills and balance, static and dynamic. The MABC-2 age band 7-10 years was used in this study. MABC-2-scores can be used to identify children who are behind their peers in motor development. All the children were tested by the same physiotherapist specialized in the field. The children were recruited from a Norwegian multicenter clubfoot study and healthy age-matched individuals were recruited from a school nearby the hospital.
Results: Eighty-nine children treated according to the traditional method (mean age 9.0 years, 7 to 10) and 93 treated a.m. Ponseti (mean age 8.8 years, 7 to 10) and 45 age matched healthy individuals were assessed. The children treated a.m. Ponseti, had serial castings (3-13 casts) starting a few days after birth. Eighty-four % of them had Achillotomy after an average of 7 castings. They had abduction braces for four years thereafter. The exact compliance concerning the recommended use of the brace is difficult to state. The number who had achillotomy was higher in the Ponseti group and the number of major operations was higher in the traditional group ( 0.001). In the control group 96 % had normal motor function, and 4 % had motor problems. In the Ponseti group 76 % had normal motor function, 9 % was categorized as having clumsiness and 14 % had motor problems, in the traditional group 76% had normal motor function, 6 % having clumsiness and 17% had motor problems. We found no difference in motor scores whether the children had undergone surgery more than the initial Achillotomy or not. The subgroups are small and one should be cautious interpreting the data.
Conclusion(s): About one- quarters of children with idiopathic clubfeet have inferior motor function compared with their peers tested in early school age according to MABC-2. Some have motor problems that might qualify for physiotherapeutic follow-up.
Implications: This study indicates that a closer follow-up concerning motor skills should be considered for patients with idiopathic clubfoot in pre-school age.
Keywords: Clubfeet;, Ponseti;, motor abilities
Funding acknowledgements: Sophies Minde Foundation
Topic: Orthopaedics; Paediatrics; Musculoskeletal
Ethics approval required: Yes
Institution: Oslo University hospital
Ethics committee: Regional committee for medical and health research, Western-Norway
Ethics number: 2010/1882
All authors, affiliations and abstracts have been published as submitted.
