The recurrent clubfoot: can gait analysis help us make better preoperative decisions?

UNLABELLED: Gait patterns in children with recurrent clubfoot are often associated with more or less subtle factors contributing to the patterns, such as tibial torsion that might not be detected by visual observation and therefore not considered in a treatment plan. We therefore used gait analysis to elucidate the contributions to recurrent clubfoot deformity and to determine whether gait analysis could be important in preoperative decision-making for these patients. We reviewed all 35 patients (56 feet) referred to our gait laboratory for recurrent deformity following treatment of idiopathic clubfoot. The average age of the children in our series was 6.7 years (range, 3.6-15.4 years). Data were acquired from computerized motion analysis, dynamic electromyography, and static measurements by a physical therapist. We found a high incidence of transverse plane deformities including intoeing in 45 of 56 feet (80%), internal tibial torsion in 40 of 56 feet (71%), and forefoot adductus in 40 of 56 feet (71%). Forty feet were supinated in stance; of these patients, 28 (70%) had overactive tibialis anterior muscle activity based on dynamic EMG. Dynamic compensatory hip external rotation was present in 28 of 56 (50%) of limbs. Thirty of the 35 patients underwent surgery following gait analysis; the most common procedures included split anterior tibial tendon transfers (34), tibial derotational osteotomies (34), and midfoot osteotomies (20). Quantitative gait analysis resulted in 28 changed procedures in 19 of 30 patients (63%) compared to prestudy surgical plans. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.