Purpose: The article by Zapata et. al. looked at 5-year olds with idiopathic clubfoot that underwent nonoperative management as an infant and reviewed gross motor development using the Peabody Developmental Motor Scales 2nd Edition at a follow-up visit.
Study Population: The study had 128 children with idiopathic clubfoot as infants treated nonoperatively. There were 85 males and 43 females with 66 children that had bilateral clubfeet and 62 children with unilateral clubfoot. At the beginning of the study, the Dimeglio scale was used to categorize the severity of the subjects’ clubfoot.
Outcome Measures: This article utilized the Peabody Developmental Motor Scales 2nd Edition to review gross motor development. In order to acquire gross motor information, researchers specifically reviewed the stationary, locomotion and object manipulation sections.
Methods/Intervention: The children were treated nonoperatively using one of two methods- Ponseti method or French functional physical therapy method. The Ponseti method used long-leg cast and orthosis while the French functional physical therapy method consisted more of exercise, tape and orthoses. Both treatments were used until age 2-3 and may include a percutaneous Achilles tenotomy, but was not considered as a surgery. During the follow-up visit around age 5, children were administered the Peabody Developmental Motor Scales 2nd Edition to get information on gross motor development in these children. The Gross Motor Quotient (GSQ) was created from the categories of stationary, locomotion and object manipulation sections.
Results: This study found no significant difference between the two nonoperative methods for treatment. The children with clubfeet scored similarly to age matched norms on the GSQ. Severity was also not significant for GMQ scores; those that required surgery were the more severe cases and therefore had a higher Dimeglio score. The differences in unilateral and bilateral clubfeet were also not significantly different. There was also no significant difference in the scores between those that required surgery versus the more conservative treatment.
Strengths/Limitations: This study was completed at the same location to maintain consistency of nonoperative treatment and follow-up testing. There was limited objective information on the success of the nonoperative treatment. It would have also been interesting to see the Peabody Developmental Motor Scales 2nd Edition used over several sessions at different ages in other words do more than one follow-up at different early ages.
Conclusion: Despite severity of clubfoot, this article found that gross motor development was not impaired significantly for children that have been treated. These findings are clinically important as it better explains that when treating children with clubfoot, the therapist should expect to see similar results to the age predicted norms.
Zapata, K., Karol, L., Jeans, K., Jo, C. Clubfoot Does Not Impair Gross Motor Development in 5-Year-Olds. Pediatric Physical Therapy. 2018;30(2):101-104.