SLR - September 2019 - Vrunda R. Dalal
Reference: Loof E, Andriesse H, André M, Bohm S, Iversen MD, Broström EW. Gross Motor Skills in Children with Idiopathic Clubfoot and the Association between Gross Motor Skills, Foot Involvement, Gait, and Foot Motion. J Pediatr Orthop. 2019 Aug; 39(7):359-365.
Scientific Literature Review
Reviewed By: Vrunda R. Dalal, DPM
Residency Program: Hoboken University Medical Center – Hoboken, NJ
Podiatric Relevance: Children with idiopathic clubfeet (IC) have an increasing prevalence of motor impairments. This article aims to study the relationship of gross motor skills to the initial severity or initial foot status of the condition mentioned. The impact of gross motor skills is crucial to the child’s gait pattern and passive foot motion.
Methods: This is a Level II Prognostic/Prospective Study evaluating children born and treated for IC in Stockholm from 2005-2008. Patient received treatment such as above knee serial casting, Achilles tenotomy and knee-ankle-foot orthosis. Inclusion criteria included ages 4.5-6.5 and previous treatment. Twenty-eight typically developed children were included for comparison. The study was assessed by five blinded assessors via videotapes. The instrument used to analyze the children is called Clubfoot Assessment Protocol, and it consists of five domains: Mobility, Muscle function, Morphology, Motion Quality I and Motion Quality II. In motion quality domain, children had to run, walk, toe-walk, heel-walk, perform a one-leg stand, and perform a one leg hop. The intraclass correlation coefficient was calculated to obtain a final score. The Mann-Whitney U test was used to compare outcomes across the different groups. The relationships between gross motor skills, gait and foot status were analyzed with the Spearman p correlations.
Results: One hundred and twenty-two total children were identified with clubfeet, however, only 47 were included. No statistical differences were found based on the initial severity vs. the treatment data as well as between the children with bilateral or unilateral clubfoot, typically developed children in age, leg length or sex. When comparing the children with clubfeet vs. typically developed children, the MQ-CAP scores were lower for clubfeet children. The bilateral IC children had significantly better scores for walking, one leg hop and total MQ-CAP. Most gross motor deviations were discovered in one leg stand, and poor correlations were found between the foot motion and initial severity. Highest correlations were found between walking and heel walking with passive dorsiflexion of the foot.
Conclusions: The authors conclude presence of gross motor deficits and asymmetries in children 5 years of age with IC. As many as 52-91 percent had deviations in toe walking, heel walking, standing or hoping. Overall, children with bilateral clubfeet performed better. The contralateral foot in IC seemed to have developed just as the typically developed foot would function. Only modest associations were found between gross motor skills and gait, passive foot motion and initial severity. The authors conclude that gross motor skills should be a component of treatment outcomes in children with clubfeet. Results of this study and the passive range of foot motion are crucial when treating severe clubfoot, especially via Ponseti technique. This article was critical in highlighting the importance of gross motor skills as the child grows. It would be important to not only treat the patient early through casting, but to combine therapy which would assist in the development of gross motor skills. The next step would be to hone in on therapy which would assist the child have proper foot function.