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Dynamic Foot-Pressure Measurement in the Assessment of Operatively Treated Clubfeet
Harry Huber, MD1; Michel Dutoit, MD2
1 Horizon 19, CH-2300 La Chaux-de-Fonds, Switzerland. E-mail address: harrym.huber@bluewin.ch
2 Hôpital Orthopédique de la Suisse Romande, University of Lausanne, Avenue Pierre-Decker 4, CH-1005 Lausanne, Switzerland
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopaedics, University of Lausanne, Switzerland

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Jun 01;86(6):1203-1210
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Abstract

Background: Decreased motion of the subtalar joint is common after operative treatment of idiopathic clubfeet. The purposes of this study were to validate parameters of dynamic foot-pressure measurement that enable detection of physiological pronation of the subtalar joint and to analyze the consequences of absent or decreased pronation following clubfoot surgery on long-term functional results.

Methods: To validate parameters of dynamic foot-pressure measurement, we initially analyzed two control groups: one of forty asymptomatic normal feet and the other of five feet with a previous subtalar joint arthrodesis. The resulting parameters were then applied to a group of nineteen patients with twenty-four idiopathic clubfeet for whom initial conservative treatment had failed and in whom a posterior surgical release (lengthening of the Achilles tendon and release of the posterior ankle capsule) had been performed at a mean age of twenty months. The mean duration of follow-up was forty-one years. All feet were evaluated radiographically, and the clinical results were assessed with the American Orthopaedic Foot and Ankle Society score.

Results: An interruption in the rise of the pressure-time curve and a short medial deviation of the center of pressure path immediately after heel strike are reliable and objective characteristics of pronation movement of the subtalar joint. Nineteen clubfeet had a demonstrable pronation movement, and five clubfeet did not. The nineteen feet with pronation movement were either asymptomatic (twelve feet) or mildly painful on occasion (seven feet). The mean American Orthopaedic Foot and Ankle Society score for the nineteen feet was 87 points. The five feet without pronation movement were moderately painful during strenuous activities only (four feet) or were nearly always painful (one foot). The mean score for those feet was 57 points. There was a significant difference between these two groups with regard to the pain scores and the total scores (p < 0.001), but there was no appreciable difference regarding function and hindfoot motion. It was not possible to distinguish between these two groups on the basis of the findings of the physical or radiographic examinations.

Conclusions: Idiopathic clubfeet with preserved hindfoot pronation have a better long-term prognosis. Preservation of functional mobility of the subtalar joint is a key factor in the treatment of clubfoot deformity.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Hasan H Muratli
    Posted on September 10, 2004
    Dynamic Foot Pressure Measurements in Patients with Club Feet
    Ankara Numune Education and Research Hospital. Department of 3rd Orthopaedics and Traumatology

    TO THE EDITOR:

    The article entitled “ Dynamic Foot-Pressure Measurement in the Assesment of Operatively Treated Clubfeet (86-A:1203-1210, June.2004)”, by Huber and Dutoit, presented dynamic foot pressure measurements of patients with subtalar arthrodesis and treated clubfeet. They found that patients with clubfoot who lacked pronation in the subtalar joint had statistically worse results than patients with clubfoot who had pronation.

    However in the Materials and Methods section of the article we could not find information on whether the 5 patients in the clubfoot group who did not have pronation movement according to dynamic foot pressure characteristics had unilateral or bilateral clubfoot involvement.The authors evaluated bilateral cases together with unilateral cases.

    We know from the literature that unilateral cases have compensatory mechanisms developed by the normal side and these mechanism can mask the real deviations from normal gait patterns (1). Therefore, we believe it is necessary for the authors to clarify the side(s) of involvement for all patients. Otherwise it is impossible to be sure that some of the unilateral cases who had pronation movement according to the gait assessment and good functional results might actually lack pronation on the involved side that is compansated by the contralateral normal side in the gait analysis. Additionally we think that the authors should state whether subtalar arthrosis was present in the treated clubfeet group which lacked of pronation in the subtalar joint. We think that the reason for pain may be the subtalar arthrosis.

    References:

    1.Davies, T.C.;, Kiefer, G.; and Zernicke, R.F.: Kinematics and kinetics of the hip, knee, and ankle of children with clubfoot after posteromedial release. J Pediatr Orthop., 21:366-371, 2001.

    Hasan Hilmi Muratli M.D. 100.Yýl Mah. 32. Cad. Kardelen Sitesi. A Blok Daire:1 Balgat Ankara-Turkey

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