Multi-segment Foot Coordination of the Ponseti Treated Clubfoot.

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Traditional kinematic measures have not led to a clear understanding of the mechanisms of functional pathology that are present in clubfeet treated with the Ponseti casting technique. The underlying mechanisms that contribute to the biomechanical and functional differences between Ponseti treated feet and healthy feet require further characterization. Differences in multi-segment foot coordination may further our understanding of the mechanisms of functional pathology of treatment. PURPOSE: To examine differences in forefoot-rearfoot and rearfoot-tibia coordination patterns during walking in children with Ponseti treated clubfeet and healthy controls. METHODS: Eight children previously treated for a clubfoot with the Ponseti casting technique (P) and six typically developing children (C) were included in this analysis. Participants walked over ground at a preferred speed while three-dimensional motion and force data were recorded. A modified vector coding technique was used to determine the bilateral coordination patterns throughout stance for forefoot-rearfoot inversion/eversion (FF-RF) and rearfoot inversion/eversion-tibia internal/external rotation (RF-Tib) coordination. The coordination patterns include: in-phase, anti-phase, distal phase and proximal phase. Coordination pattern frequency for each couple was averaged over early stance (0-33%), midstance (34-66%) and late stance (67-100%) for each group. Effect Size (ES) was calculated to determine differences in frequency of coordination patterns between groups throughout stance. RESULTS: There was a large effect of group on frequency of distal phase FF-RF coordination (P=0 and C=2.5; ES=0.78) and anti-phase RF-Tib coordination (P=12.6 and C=3.7; ES=0.82) during early stance. During late stance there was a moderate effect of proximal phase FF-RF coordination (P=9.1 and C=4.2; ES=0.53) and distal, anti- and proximal phase RF-Tib coordination (P=28.6 and C=20.2; ES=0.68, P=1.5 and C=6.8; ES=0.66, P=0.5 and C=2.8; ES=0.66). CONCLUSION: Differences in FF-RF and RF-Tib coordination patterns were most notable in early and late stance. These differences suggest the presence of residual clubfoot pathology in Ponseti treated feet and indicate an adoption of compensatory movement strategies to carry out the everyday task of walking.