Quantification of differences in lower-limb appearance between idiopathic clubfeet treated by ponseti casting method versus normal feet in young children

Abstract

Despite excellent functional correction of club foot, the appearance of the treated lower-limb differs morphologically from normal lower-limbs which has been described qualitatively in the past. The purpose of this study is to quantify the lower-limb appearance between idiopathic ponseti-treated clubfeet versus normal feet in terms of foot length, calf girth and internal tibial torsion in a group of young children. Materials and methods: 49 club foot patients (29 unilateral, and 20 bilateral) below the age of 12 months were treated using the Ponseti casting method. When patients reached walking age (average 14 months), the evaluation was done using the Pirani score. Upon a score of 0 (indicating full correction), the lower-limb appearance was defined by foot length, calf girth, and internal tibial torsion measurements. Results: Of the 29 patients with unilateral clubfoot (age: 14 ± 3 months), 86% had smaller foot length (11.9 ± 0.7 cm, p < 0.05), 69% had smaller calf girth (17.1 ± 1.7 cm, p < 0.05) and 79% had larger internal tibial torsion (16.1° ± 3.7°, p < 0.001) in comparison to normal lower-limbs (n=19). Of the 20 patients with bilateral clubfeet (age: 14 ± 3 months), 100% had smaller foot length (12.0 ± 0.7 cm, p < 0.05), 60% had smaller calf girth (17.1 ± 1.4 cm, p < 0.05) and 74% had larger internal tibial torsion (15.3° ± 3.9°, p < 0.001) in comparison to age-matched normal lower-limbs (n=19). However, when comparing all treated lower-limbs (n=49) to normal lower-limbs (n=20), 82% had significant difference in all these parameters. Conclusion: Children with Idiopathic Club Feet treated with Ponseti exhibit significant quantitative differences in terms of smaller foot length, smaller calf-girth and larger internal rotation as compared to normal individuals. Prior counselling of parents regarding these differences in unilateral cases is recommended.