Functional Assessment in Children With Clubfoot
Condition: Clubfoot
MeSH terms: Clubfoot; Talipes; Equinus Deformity
Study type: Observational

Summary: 
      The aim of this study was to determine ankle-foot characteristics, load distribution on foot,
      balance-proprioception, functional activity skills, disability and quality of life levels in
      children treated with Ponseti's method, finding out the asymetries between both feet in each
      group, to determine the differences between the healthy foot and the clubfeet, and also to
      examine the relationship between all parameters in healty children and children with
      clubfoot.

      51 children ages ranging 5 to 15, were included in this study. In order to evaluate foot
      characteristics, anthropometric measurements were applied. FPI-6 is used for foot
      posture.Fizyosoft Balance System is used to measure the balance and proprioception.
      Functional activity were evaluated with Functional Activity and Skills Form. Disability were
      evaluated with OxAFQ-C and OxAFQ-P and KINDL forms are used to assess quality of life.
    

Detailed description: 
      Pes Equinovarus (PEV) is one of the complex pediatric foot deformities that has a prevalence
      of 1-2/1000 live births and requires intensive treatment. The majority of patients with
      clubfeet have the idiopathic form. Men have a higher risk of exposure with a rate of 2-4/1000
      compared to women, and bilateral involvement is present in half of the patients. Each child
      can be affected at different levels according to their mobility and morphological
      characteristics. The shape and function of the foot are greatly affected by the four
      components (CAVE) as adductus in the forefoot, cavus in the midfoot, varus in the hindfoot
      and equinus deformity in the ankle that make up the complex structure of the disease. It has
      been reported that children with Pes Equinovarus may experience problems with
      balance-coordination, gross motor skills and muscle strength due to the complex nature of the
      disease and an unsuccessful treatment, and also their quality of life may be adversely
      affected due to difficulties in daily activities.

      Treatment of the disease is basically in two ways: operative and/or non-operative
      (conservative). The main goals of both treatments are to improve the mobility of the foot by
      correcting the four orthopedic deformities that constitute the complex nature of the disease,
      and to create a functional, painless, full contact with the ground and not needing modified
      shoes. The Ponseti method, which is one of the conservative treatment methods that is gold
      standart for the treatment of clubfoot, is a multi-stage method that requires gentle
      manipulation, weekly serial casting with a special technique, Achilles tenotomy if necessary,
      and the use of foot abduction orthosis after casting.

      Although the clinical and functional results after Ponseti treatment were promising,
      deviations in plantar pressure distribution were found as a result of pedobarographic
      measurements and gait analyzes in unilateral and bilateral feet. It was stated that the
      dimensions of the unilateral foot were smaller than the contralateral foot, and it was stated
      that the contralateral foot could have different sizes compared to the normally developing
      foot. There is no definite judgment about foot anthropometry, due to the existence of studies
      stating that the sizes of the affected and contra-lateral feet are similar in unilateral
      involvement.

      Balance is another parameter that is stated to be negatively affected depending on foot
      involvement and the severity of the deformity, but studies examining balance and
      activity-participation levels are very limited.In addition to studies stating that there is a
      difference in foot-ankle characteristics, plantar pressure distribution and gross motor
      skills in children who have received Ponseti treatment, there are also studies stating the
      opposite. The number of studies on activities of daily living and quality of life is quite
      limited, and there was any study examining balance and proprioception according to unilateral
      and bilateral involvement.

      For this reason, the aim of this study was to compare the foot-ankle characteristics, plantar
      pressure distribution, functional activity skills, disability, quality of life and
      balance-proprioception levels in children treated with the Ponseti method primarily with
      unilateral-bilateral involvement as well as with children who maintain normal development. To
      examine the relationship between balance-proprioception involvement and functional activity
      skills, disability and quality of life in children with clubfoot.

      51 children ages ranging 5 to 15, were included in this study. In order to evaluate foot
      characteristics, anthropometric measurements were applied. FPI-6 is used for foot
      posture.Fizyosoft Balance System is used to measure the balance and proprioception.
      Functional activity were evaluated with Functional Activity and Skills Form. Disability were
      evaluated with OxAFQ-C and OxAFQ-P and KINDL forms are used to assess quality of life.

      While performing the statistical analysis of the data and creating the table, the affected
      foot was defined as the 'inferior' (inf) and the unaffected-contralateral foot as the
      'superior' (sup) foot, considering the Dimeglio scores for the superior and inferior foot
      determination for the unilateral group (UG).

      In the bilateral group (BG) and the healthy group (SG), the foot on the side on which they
      wrote (dominant hand) was called 'superior' and the non-dominant side was called 'inferior',
      since there was no difference between the Dimeglio scores of the children in both feet.
    

Intervention name(s): assessment
Intervention type(s): Other
Intervention description(s): Application of various assessment methods to determine the foot characteristics, foot posture, functional activity, balance levels and quality of life of the determined groups.
Observational model: Cohort
Time perspective: Other
Sampling method: Non-Probability Sample
Study population: 
        Clubfoot groups: Diagnosed with idiopathic unilateral and bilateral clubfoot

        Healty group : To be called "healthy" who continue their normal developmental stages and
        not diagnosed with orthopedic disease.
      
Keywords: Balance; Disability; Foot anthropometry; Pes eqinovarus; Quality of life