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Dynamic Foot-Pressure Measurement in the Assessment of Operatively Treated Clubfeet

¹ Horizon 19, CH-2300 La Chaux-de-Fonds, Switzerland. E-mail address: harrym.huber{at}bluewin.ch
² Hôpital Orthopédique de la Suisse Romande, University of Lausanne, Avenue Pierre-Decker 4, CH-1005 Lausanne, Switzerland

Investigation performed at the Department of Orthopaedics, University of Lausanne, Switzerland

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.

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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				K. B. Park, H. W. Park, K. S. Lee, S. Y. Joo, and H. W. Kim Changes in Dynamic Foot Pressure After Surgical Treatment of Valgus Deformity of the Hindfoot in Cerebral Palsy J. Bone Joint Surg. Am., August 1, 2008; 90(8): 1712 - 1721. [Abstract] [Full Text] [PDF]

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