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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