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Deutscher Kongress für Orthopädie und Unfallchirurgie, 75. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 97. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 52. Tagung des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie

25. - 28.10.2011, Berlin

Prospective functional study of postsurgical clubfeet in comparison with a healthy group looking at pedobarographic features and characteristics

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  • J. Weingärtner - Orthopädische Klinik, Kinderorthopädie, Universität Regensburg, Bad Abbach- Regensburg, Germany
  • J. Matussek - Orthopädische Klinik, Kinderorthopädie, Universität Regensburg, Bad Abbach- Regensburg, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie. 75. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 97. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 52. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 25.-28.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocWI40-1666

DOI: 10.3205/11dkou230, URN: urn:nbn:de:0183-11dkou2304

Published: October 18, 2011

© 2011 Weingärtner et al.
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Outline

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Questionnaire: In the past decade aggressive corrective peritalar release surgery in type III/IV Dimeglio clubfeet has produced criticism due to unfavourable results with regard to postoperative stiffness and bone deformities. Although the postoperative results seem acceptable at first sight, functional results did not always fulfill the desired criteria; in particular the roll-over process from heel contact towards toe-off seemed compromised. Short foot length together with a more supinated midfoot and toe-off roll-over phase characterized those operated feet which clinically presented stiffness and a flat-top talus deformity. Readily available pedobarographic insoles to measure rapid pressure changes during gait give sufficient indirect kinematic data and register relative pressure changes during the roll-over process. This enables the clinician to compare pedobarographic and indirect kinematic data of postoperative clubfeet with data acquired from healthy subjects.

Methods: 25 children between 6 and 8 yrs.(f: 14/m:11) who had clubfoot surgery at the Paediatric Orthopaedic Department at 6 months of age. All children had a one sided conservatively pretreated severe clubfoot (left: 9/right:16) Dimeglio III/IV that underwent a standardized peritalar release (2 surgeons) according to the protocol described by Turco (n: 18 ) and Crawford (n:7). In this study the major steps of these different protocols were considered equivalent. 9 of these children later underwent an additional transfer of the anterior tibial tendon towards the IV metatarsal

These children underwent visual and pedobarographic gait analysis with a wireless 64-pressure-sensor 60-Hz system; all had standardized foot x-ray. A control group of 20 clinically healthy feet rendered so-called normal pressure distribution data.

Results and Conclusions: Children with a favourable clinical outcome presented gait and pressure distribution data attributed to plano-valgus deformities (n:16), whereas those with high degree of stiffness (n:7) qualified with a shortened COP line ,a relative hindfoot varus and a lateralized toe-off. X-ray demonstrated various degrees of talar deformities in those 7 stiff feet which were characterized in detail. Only two postsurgical feet presented the known adult pressure distribution pattern. Data from the control group surprised with a high degree of variation and although clinically normal, foot pressure patterns from highly supinated to plano-valgus were observed.

Discussion : Functional insights into the postsurgical clubfoot mechanics and indirect kinematics are easily available with pedobarography and comparable functional evaluation is at hand. Valid data of healthy children though present a high degree of variation- sometimes suggesting pathology even in the superficially as normal classified foot- which requires a further defining process into what is the normal functional range of a child´s foot.