Prospective Study of Gross Motor Milestones in Children with Severe Idiopathic Clubfoot Treated by Ponseti Method.

BACKGROUND: A prospective study of motor milestones achieved in severe clubfeet treated by Ponseti method and comparison between unilateral and bilateral clubfoot will help us gain further insight of motor milestones in these children. METHODS: Prospective study of 150 consecutive children with idiopathic clubfoot who were treated by Ponseti method and in whom percutaneous tendoachilles tenotomy was performed. The gross motor milestones recorded were: rolls from back to stomach, sitting without support, standing with assistance, walks with assistance, standing alone, walking alone. This was compared with published regional and World Health Organization (WHO) normal data. RESULT: 15 patients were excluded due to non-compliance and recurrence. Children with unilateral clubfoot (80 children) and bilateral clubfoot (55 children) showed a delay of 0.2-2.1 months in various milestones, and this was statistically significant when compared with both normal data. 95% children with unilateral clubfoot had independent ambulation by 17 months and in bilateral ambulation by 17.8 months. There was also a statistically significant difference in unilateral and bilateral clubfeet in all variables except sitting without support and walking with support. CONCLUSION: There is a delay in achievement in all children with clubfoot, with more delay in bilateral clubfoot as compared to unilateral clubfoot. The probable reasons could be plaster treatment, possible weakness due to tendoachilles tenotomy, use of orthosis or the inherent pathology associated with clubfeet. Parents hence need to be explained about this delay.

Bone mineral density of proximal femur and spine in Korean children between 2 and 18 years of age.

Ethnic factors affect bone mass acquisition during childhood. The aim of our study was to establish normative data for bone mineral content (BMC) and bone mineral density (BMD) in healthy Korean children and adolescents, using 446 lumbar spine scans (224 males and 222 females) and 364 proximal femur scans (181 males and 183 females) of healthy children between ages 2 and 18 years measured by dual-energy X-ray absorptiometry using Hologic QDR Discovery A 2004. There was an increase in both BMC and BMD during early childhood, acceleration during the adolescence spurt, and a slower increase later. Until 11 years of age, both male and female BMC and BMD were not statistically different. There was a rapid increase in both BMC and BMD in females earlier than in males, and later males caught up with the females and overshot the female values. When compared with Canadian children, BMD and BMC of total proximal femur was found to be more and BMD and BMC of total lumbar spine to be less at some ages. Tanner's stage was significantly associated with BMD and BMC of spine and proximal femur in males and BMC of spine in females in the first three Tanner's stages. Height, body weight, fat content, and body mass index influenced BMC and BMD at different sites by variable amount. Hence, the values presented in this study should be used as reference values in Korean children and adolescents.

Effect of foot deformity on conventional mechanical axis deviation and ground mechanical axis deviation during single leg stance and two leg stance in genu varum.

We assessed the effect of foot deformity on the loading axis of lower limbs in 33 patients with genu varum (25 bilateral and eigth unilateral) caused by varying etiologies including achondroplasia, cerebral palsy, prior trauma, rickets, metaphyseal chondrodysplasia and primary osteoarthritis using single leg stance and both leg stance radiographs. Deviation at the knee from the hip ankle line (conventional) and hip foot line (centre of hip to centre of heel) was calculated. A comparison was made between single leg stance and two leg stance for tibiocalcaneal angle, mechanical axis angle, knee and ankle joint line convergence angle, conventional mechanical axis deviation (MADC) and ground mechanical axis deviation (MADG). In addition comparisons were also made among three groups formed depending on the tibiocalcaneal angle and MADC-MADG difference for all the above measurements. Mechanical axis deviation (calculated using the two methods) varied with the talocalcaneal angle and single leg stance. Patients with a fixed subtalar varus and with severe genu varum, where the normal compensatory subtalar eversion could not compensate showed that conventional mechanical axis deviation was significantly higher by 3.4+/-2.4 mm and ground mechanical axis deviation degrees was significantly higher by 3.8+/-3.2 mm in single leg stance when compared to two leg stance (p<.0001). Foot deformity should be included during preoperative evaluation and planning for knee deformity correction.