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Standing and walking age in children with idiopathic clubfoot: French physiotherapy versus Ponseti method
A Zanardi1, V Fortini2, C N Abati1
1Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children's Hospital, Florence, Italy.
Insights
Infants with clubfoot experience mild delays in motor development. Both the Ponseti method (PM) and French method (FM) treatments showed no significant difference in achieving gross motor milestones like walking.
Area of Science:
- Pediatric Orthopedics
- Developmental Pediatrics
- Physical Therapy
Background:
- Infants with clubfoot often exhibit delayed gross motor milestones and walking age.
- The impact of different clubfoot treatments on motor development remains under-investigated.
- Concerns exist that the Ponseti method's (PM) immobilization may hinder development more than the French method (FM).
Purpose of the Study:
- To compare the achievement of key motor milestones (pull-to-standing, cruising, independent walking) in infants treated with the Ponseti method versus the French method.
- To evaluate the influence of treatment modality on motor development in clubfoot patients.
Main Methods:
- Prospective enrollment of 52 infants with clubfoot, with 26 treated at each of two experienced centers using either PM or FM.
- Follow-up until walking age to record the achievement of specific gross motor milestones.
- Data collected included age at treatment initiation, Dimeglio score, tenotomy rates, and milestone achievement ages.
Main Results:
- No significant differences were observed between the PM and FM groups in the age of achieving pull-to-standing, cruising, or independent walking.
- Infants treated with PM had a significantly lower age at tenotomy, and higher severity and bilaterality.
- Overall, clubfoot patients achieved milestones approximately two months later than the normal population, irrespective of treatment method, sex, severity, laterality, or tenotomy necessity.
Conclusions:
- Infants diagnosed with clubfoot typically experience a mild delay in gross motor development.
- The Ponseti method and the French method demonstrate comparable outcomes regarding the achievement of gross motor milestones at walking age.
- Treatment approach does not appear to significantly impact the timing of major motor milestones in clubfoot patients.
Purpose:
A mild delay in gross motor milestones and walking age has been reported in infants with clubfoot. The influence of different treatments on motor development has been poorly investigated. Some parents and physical therapists express concern that the Ponseti method (PM) and its constraints (abduction brace, casts) would affect development more than the French physical therapy method (FM) due to greater immobilization and lesser stimulation.The purpose of this study was to evaluate achievement of three motor milestones (pull-to-standing, cruising and independent walking) in two groups of clubfoot patients treated at two experienced institutes respectively with the PM and FM.
Methods:
In all, 52 consecutive infants (full-term at birth, mean age at beginning of treatment 24.3 days (sd 10), mean Dimeglio score 12 (sd 3.4)) were prospectively enrolled (26 patients per centre) and followed up to walking age recording milestones.
Results:
The two groups were not different in terms of age at the beginning of treatment (p = 0.067) and rate of tenotomy. Age at tenotomy was significantly lower in the PM group (p = 0.000). Severity (p = 0.004) and number of bilateral cases (p = 0.012) were higher in the PM group. A non-significant difference was found for age of achievement of pull-to-standing (p = 0.109), cruising (p = 0.253) and independent ambulation (p = 0.349) between the two groups. Overall, milestones were achieved approximately two months later than normal population. Sex, severity, laterality and need of tenotomy were not found to significantly influence milestones.
Conclusion:
Our results confirmed that infants with clubfoot are expected to have a minimum delay in motor development. Infants treated with the PM and those treated with the FM did not show significant differences in gross motor milestones achievement at walking age.
Level Of Evidence:
Level II - Prospective comparative therapeutic studies.
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