Functional Assessment in Children With Clubfoot

NCT ID: NCT05456737

Last Updated: 2022-07-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

51 participants

Study Classification

OBSERVATIONAL

Study Start Date

2020-01-15

Study Completion Date

2021-02-26

Brief Summary

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The aim of this study was to determine ankle-foot characteristics, load distribution on foot, balance-proprioception, functional activity skills, disability and quality of life levels in children treated with Ponseti's method, finding out the asymetries between both feet in each group, to determine the differences between the healthy foot and the clubfeet, and also to examine the relationship between all parameters in healty children and children with clubfoot.

51 children ages ranging 5 to 15, were included in this study. In order to evaluate foot characteristics, anthropometric measurements were applied. FPI-6 is used for foot posture.Fizyosoft Balance System is used to measure the balance and proprioception. Functional activity were evaluated with Functional Activity and Skills Form. Disability were evaluated with OxAFQ-C and OxAFQ-P and KINDL forms are used to assess quality of life.

Detailed Description

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Pes Equinovarus (PEV) is one of the complex pediatric foot deformities that has a prevalence of 1-2/1000 live births and requires intensive treatment. The majority of patients with clubfeet have the idiopathic form. Men have a higher risk of exposure with a rate of 2-4/1000 compared to women, and bilateral involvement is present in half of the patients. Each child can be affected at different levels according to their mobility and morphological characteristics. The shape and function of the foot are greatly affected by the four components (CAVE) as adductus in the forefoot, cavus in the midfoot, varus in the hindfoot and equinus deformity in the ankle that make up the complex structure of the disease. It has been reported that children with Pes Equinovarus may experience problems with balance-coordination, gross motor skills and muscle strength due to the complex nature of the disease and an unsuccessful treatment, and also their quality of life may be adversely affected due to difficulties in daily activities.

Treatment of the disease is basically in two ways: operative and/or non-operative (conservative). The main goals of both treatments are to improve the mobility of the foot by correcting the four orthopedic deformities that constitute the complex nature of the disease, and to create a functional, painless, full contact with the ground and not needing modified shoes. The Ponseti method, which is one of the conservative treatment methods that is gold standart for the treatment of clubfoot, is a multi-stage method that requires gentle manipulation, weekly serial casting with a special technique, Achilles tenotomy if necessary, and the use of foot abduction orthosis after casting.

Although the clinical and functional results after Ponseti treatment were promising, deviations in plantar pressure distribution were found as a result of pedobarographic measurements and gait analyzes in unilateral and bilateral feet. It was stated that the dimensions of the unilateral foot were smaller than the contralateral foot, and it was stated that the contralateral foot could have different sizes compared to the normally developing foot. There is no definite judgment about foot anthropometry, due to the existence of studies stating that the sizes of the affected and contra-lateral feet are similar in unilateral involvement.

Balance is another parameter that is stated to be negatively affected depending on foot involvement and the severity of the deformity, but studies examining balance and activity-participation levels are very limited.In addition to studies stating that there is a difference in foot-ankle characteristics, plantar pressure distribution and gross motor skills in children who have received Ponseti treatment, there are also studies stating the opposite. The number of studies on activities of daily living and quality of life is quite limited, and there was any study examining balance and proprioception according to unilateral and bilateral involvement.

For this reason, the aim of this study was to compare the foot-ankle characteristics, plantar pressure distribution, functional activity skills, disability, quality of life and balance-proprioception levels in children treated with the Ponseti method primarily with unilateral-bilateral involvement as well as with children who maintain normal development. To examine the relationship between balance-proprioception involvement and functional activity skills, disability and quality of life in children with clubfoot.

51 children ages ranging 5 to 15, were included in this study. In order to evaluate foot characteristics, anthropometric measurements were applied. FPI-6 is used for foot posture.Fizyosoft Balance System is used to measure the balance and proprioception. Functional activity were evaluated with Functional Activity and Skills Form. Disability were evaluated with OxAFQ-C and OxAFQ-P and KINDL forms are used to assess quality of life.

While performing the statistical analysis of the data and creating the table, the affected foot was defined as the 'inferior' (inf) and the unaffected-contralateral foot as the 'superior' (sup) foot, considering the Dimeglio scores for the superior and inferior foot determination for the unilateral group (UG).

In the bilateral group (BG) and the healthy group (SG), the foot on the side on which they wrote (dominant hand) was called 'superior' and the non-dominant side was called 'inferior', since there was no difference between the Dimeglio scores of the children in both feet.

Conditions

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Clubfoot

Study Design

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Observational Model Type

COHORT

Study Time Perspective

OTHER

Study Groups

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Unilateral Group

Participants with a diagnosis of unilateral clubfoot treated with the Ponseti method were evaluated once with the following evaluation methods:

Anthropometric measurements FPI-6 Fizyosoft Balance System Functional Activity and Skills Form. OxAFQ-C and OxAFQ-P Kiddy-Kid-Kiddo KINDL

assessment

Intervention Type OTHER

Application of various assessment methods to determine the foot characteristics, foot posture, functional activity, balance levels and quality of life of the determined groups.

Bilateral Group

Participants with a diagnosis of bilateral clubfoot treated with the Ponseti method were evaluated once with the following evaluation methods:

Anthropometric measurements FPI-6 Fizyosoft Balance System Functional Activity and Skills Form. OxAFQ-C and OxAFQ-P Kiddy-Kid-Kiddo KINDL

assessment

Intervention Type OTHER

Application of various assessment methods to determine the foot characteristics, foot posture, functional activity, balance levels and quality of life of the determined groups.

Healty Group (Control)

Healthy participants with normal development were evaluated once with the following evaluation methods:

Anthropometric measurements FPI-6 Fizyosoft Balance System Functional Activity and Skills Form. OxAFQ-C and OxAFQ-P Kiddy-Kid-Kiddo KINDL

assessment

Intervention Type OTHER

Application of various assessment methods to determine the foot characteristics, foot posture, functional activity, balance levels and quality of life of the determined groups.

Interventions

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assessment

Application of various assessment methods to determine the foot characteristics, foot posture, functional activity, balance levels and quality of life of the determined groups.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. For the Healty group (control)

* To be volunteer
* Being between the ages of 5-15
* Having signed the informed consent form
* To be approved by the orthopedist that he does not have any orthopedic problems that would prevent walking, balance and activities of daily living, especially standing
* Not having any neurological disorders
2. For the Pes Equinovarus groups:

* To be volunteer
* Being between the ages of 5-15
* Having signed the informed consent form
* To be diagnosed with idiopathic pes equinovarus
* Being treated primarily with the Ponseti method
* Being able to stand without support
* Being able to walk without an assistive device

Exclusion Criteria

* Having a diagnosis of neurologic clubfoot
* clubfoot associated with severe syndromes such as myelomeningocele or Down syndrome, Larsen, Diastrophic Dysplasia
* Diagnosing congenital joint contractures such as Arthrogryposis Multiplex Congenita
* To have an operative treatment for Pes Echinovarus in the last 1 year
* Refusing to participate in the study
Minimum Eligible Age

5 Years

Maximum Eligible Age

15 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Medipol University

OTHER

Sponsor Role lead

Responsible Party

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Özlem Aydın

Physiotherapist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Özlem Aydın, M.Sc.

Role: PRINCIPAL_INVESTIGATOR

Medipol University

Devrim Tarakçı, Assoc. Prof.

Role: STUDY_DIRECTOR

Medipol University

Locations

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Dilbade Special Education and Rehabilitation Center

Istanbul, Eyüp, Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

References

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Xu C, Wei J, Yan YB, Shang L, Yang XJ, Huang LY, Lei W. Pedobarographic Analysis following Ponseti Treatment for Unilateral Neglected Congenital Clubfoot. Sci Rep. 2018 Apr 19;8(1):6270. doi: 10.1038/s41598-018-24737-w.

Reference Type BACKGROUND
PMID: 29674653 (View on PubMed)

Sangiorgio SN, Ebramzadeh E, Morgan RD, Zionts LE. The Timing and Relevance of Relapsed Deformity in Patients With Idiopathic Clubfoot. J Am Acad Orthop Surg. 2017 Jul;25(7):536-545. doi: 10.5435/JAAOS-D-16-00522.

Reference Type BACKGROUND
PMID: 28574943 (View on PubMed)

Gelfer Y, Dunkley M, Jackson D, Armstrong J, Rafter C, Parnell E, Eastwood DM. Evertor muscle activity as a predictor of the mid-term outcome following treatment of the idiopathic and non-idiopathic clubfoot. Bone Joint J. 2014 Sep;96-B(9):1264-8. doi: 10.1302/0301-620X.96B9.33755.

Reference Type BACKGROUND
PMID: 25183601 (View on PubMed)

Garcia-Gonzalez NC, Hodgson-Ravina J, Aguirre-Jaime A. Functional physiotherapy method results for the treatment of idiopathic clubfoot. World J Orthop. 2019 Jun 18;10(6):235-246. doi: 10.5312/wjo.v10.i6.235. eCollection 2019 Jun 18.

Reference Type BACKGROUND
PMID: 31259147 (View on PubMed)

Cosma D, Vasilescu DE. A Clinical Evaluation of the Pirani and Dimeglio Idiopathic Clubfoot Classifications. J Foot Ankle Surg. 2015 Jul-Aug;54(4):582-5. doi: 10.1053/j.jfas.2014.10.004. Epub 2014 Nov 13.

Reference Type BACKGROUND
PMID: 25458441 (View on PubMed)

Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am. 2004 Jan;86(1):22-7. doi: 10.2106/00004623-200401000-00005.

Reference Type RESULT
PMID: 14711941 (View on PubMed)

Zapata KA, Karol LA, Jeans KA, Jo CH. Gross Motor Function at 10 Years of Age in Children With Clubfoot Following the French Physical Therapy Method and the Ponseti Technique. J Pediatr Orthop. 2018 Oct;38(9):e519-e523. doi: 10.1097/BPO.0000000000001218.

Reference Type RESULT
PMID: 29965933 (View on PubMed)

Andriesse H, Westbom L, Hagglund G. Motor ability in children treated for idiopathic clubfoot. A controlled pilot study. BMC Pediatr. 2009 Dec 15;9:78. doi: 10.1186/1471-2431-9-78.

Reference Type RESULT
PMID: 20003483 (View on PubMed)

Agarwal A, Rastogi A. Anthropometric measurements in Ponseti treated clubfeet. SICOT J. 2018;4:19. doi: 10.1051/sicotj/2018010. Epub 2018 May 25.

Reference Type RESULT
PMID: 29806584 (View on PubMed)

Loof E. Additional challenges in children with idiopathic clubfoot: is it just the foot? J Child Orthop. 2019 Jun 1;13(3):245-251. doi: 10.1302/1863-2548.13.190076.

Reference Type RESULT
PMID: 31312263 (View on PubMed)

Related Links

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Other Identifiers

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10840098-604.01.01-E.1590 / 56

Identifier Type: -

Identifier Source: org_study_id

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