Chen Qiuyue, Salami Firooz, Putz Cornelia, Wolf Sebastian I
Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany.
J Child Orthop. 2025 Sep 2:18632521251369353. doi: 10.1177/18632521251369353.
This study aimed to investigate foot kinematics during gait in individuals with idiopathic clubfoot initially treated with the Ponseti method, focusing on clubfoot-specific deformities, to improve the understanding of posttreatment functional impairments.
In this prospective cohort study, 23 patients with treated idiopathic clubfoot (34 feet) were compared with 15 age-matched healthy controls (30 feet). Gait analysis was performed using the Heidelberg Foot Model. To characterize residual clubfoot deformities, selected kinematic parameters included medial arch and subtalar angles, as well as intersegmental angles between hindfoot-shank and forefoot-hindfoot, based on more functional joint centers. Within the patient group, potential influence of additional surgical interventions was explored.
Compared with controls, treated idiopathic clubfoot exhibited significant reductions in hindfoot sagittal and transverse range of motion, forefoot sagittal range of motion, and medial arch mobility. Equinus deformity was not present posttreatment, as dorsiflexion metrics during stance did not differ significantly. However, plantarflexion range of motion during the transition to swing was reduced. In addition, treated idiopathic clubfoot showed persistent subtalar inversion and hindfoot varus, increased mid-stance adductus in both hindfoot and forefoot, and pronounced arch stiffness during transition to swing. Within the patient group, ankle and subtalar capsulotomy was associated with increased medial arch cavus.
Patients with treated idiopathic clubfoot exhibit a functionally stiffer foot with altered alignment during gait, contributing to impaired limb advancement. The results expand the understanding of residual clubfoot deformities and highlight the importance of detailed functional assessment posttreatment, providing a foundation for future research.
Level II, prognostic study.
本研究旨在调查最初采用Ponseti方法治疗的特发性马蹄内翻足患者在步态中的足部运动学，重点关注马蹄内翻足特有的畸形，以增进对治疗后功能障碍的理解。
在这项前瞻性队列研究中，将23例接受治疗的特发性马蹄内翻足患者（34只脚）与15名年龄匹配的健康对照者（30只脚）进行比较。使用海德堡足部模型进行步态分析。为了描述残留的马蹄内翻足畸形，基于更多功能关节中心，选择的运动学参数包括内侧足弓和距下关节角度，以及后足-小腿和前足-后足之间的节段间角度。在患者组中，探讨了额外手术干预的潜在影响。
与对照组相比，接受治疗的特发性马蹄内翻足在后足矢状面和横向运动范围、前足矢状面运动范围以及内侧足弓活动度方面均有显著降低。治疗后不存在马蹄畸形，因为站立期背屈指标无显著差异。然而，向摆动期过渡时的跖屈运动范围减小。此外，接受治疗的特发性马蹄内翻足表现出持续的距下关节内翻和后足内翻，后足和前足在站立中期内收增加，以及向摆动期过渡时足弓明显僵硬。在患者组中，踝关节和距下关节囊切开术与内侧足弓高弓畸形增加有关。
接受治疗的特发性马蹄内翻足患者在步态中表现出功能上更僵硬的足部，对线改变，导致肢体推进受损。这些结果扩展了对残留马蹄内翻足畸形的理解，并突出了治疗后详细功能评估的重要性，为未来的研究奠定了基础。
II级，预后研究。
