Size Differences Seen in Clubfoot-Involved Foot and Leg Not Related to Treatment

GLASGOW — In children with unilateral clubfoot, the involved foot and leg will be approximately 10% smaller than the uninvolved leg and foot, and that percent difference does not seem to change significantly with growth and development, according to the results of a prospective, longitudinal study.

James G. Gamble, MD, PhD, presented the results of his teams’ study here, at the 2010 Meeting of the Combined Orthopaedic Associations.

  James G. Gamble
  James G. Gamble

Through their investigation, Gamble and colleagues sought to answer the questions they are asked by most parents of children with unilateral clubfoot.

“The purpose of our work was to try to come up with some answers,” Gamble said. “We wanted to determine a percent difference between a normal and involved leg and foot, we wanted to see if that difference changed over time, and finally we wondered if the type of treatment made any difference in terms of the outcome.”

Gamble and colleagues included 87 patients in their study with a rigid unilateral clubfoot and excluded any whose condition resolved with casting or stretching, those with neuromuscular conditions and genetic syndromes, and those who underwent initial treatment elsewhere.

Patients were subdivided according to treatment type; 64 patients underwent posterior medial release between 1987 and 2001, and 23 patients were treated with the Ponseti method between 2001 and 2008. Average follow-up was 84 months for the posteromedial release group and 36 months for the Ponseti group. Calf girth and foot length were measured at follow-up visits using a tape measure, according to Gamble.

Gamble reported a 10% average difference in calf girth between the involved and uninvolved limbs in patients who underwent a posteromedial release. An 8% difference was observed in those patients who were treated with the Ponseti technique.

The average difference in foot length was 8% in the posteromedial release group, and 9% for the Ponseti group. Gamble noted that there was no significant difference between these numbers.

“And finally, the differences seem to be intrinsic to the condition, not to the type of treatment,” Gamble concluded.

For more information:

  • Gamble J, et al. How small is the leg and foot in unilateral clubfoot? Presented at the 2010 Meeting of the Combined Orthopaedic Associations. Sept. 12-17. Glasgow.

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