Researcher(s)
- Angeline Bui, Neuroscience, University of Delaware
Faculty Mentor(s)
- Chris Church, Department of Orthopedics, Nemours Children’s Hospital
- Reid Nichols, Department of Orthopedics, Nemours Children’s Hospital
Abstract
The Ponseti method is effective in treating clubfoot, but recurrence of the deformity occurs in 26% to 48% of children. Serial casting and surgery are common methods for treating relapsed clubfoot, but physical therapy (PT) may offer a more conservative treatment option. Our aim is to assess the impact of PT on foot passive range of motion (PROM), gait pattern, and gross motor function in children with relapsed clubfoot.
This study included a convenience sample of ambulatory children diagnosed with clubfoot who were initially treated with the Ponseti method but had recurrence of clubfoot. In this IRB-approved retrospective study, children completed a PT episode that addressed stretching, strengthening, and gross motor skills. Flexibility/foot position was assessed with ankle dorsiflexion, forefoot abduction PROM, and Pirani/Böhm/Sinclair (PBS) Scores. Functional outcomes included single limb stance time, single hop length, broad jump length, and observational gait score. To determine long term effectiveness of PT, the need for foot surgery after PT discharge was obtained from the medical record. Differences between initial PT evaluation and PT discharge evaluation were analyzed using paired t-tests or Wilcoxon signed-rank tests, as appropriate.
After PT, all outcome measures showed statistically significant improvement (p<0.05). Following an average of 7±3 years after PT discharge, 67% of children required surgical intervention to correct persistent clubfoot deformities. PT can effectively reduce foot deformities and improve functional outcomes in children with recurrent clubfoot despite the need for surgery for definitive correction in many cases.