שנה שפה:

The Efect of Tenotomy on Kinematics, Kinetics and Pressure Parametres in Children with Idiopathic Clubfoot



Robert Elbaum1, Celine Mahieu2, Clementine Concessa4, Francoise Adam5, Brigitte Noel6, Benoit Beyer2,4, Frederic Schuind7, Veronique Feipel2,4, Patrick Salvia2,3
1 Orthopaedic, 3 CHIREC Orthopaedic Group, Brussels, Belgium
2 Faculty of Medicine, Laboratory of Anatomy, Biomechanics and Organogenesis, Brussels, Belgium
3 Faculty of Medicine,Université Libre de Bruxelles, Center for Funtional Evaluation, Brussels, Belgium
4 Université Libre de Bruxelles, Laboratory for Functional Anatomy, Brussels, Belgium
5 Erasme Hospital ,Université Libre de Bruxelles, Department of Physical Therapy, Brussels, Belgium
6 Iris South Hospital, Department of Physical Therapy, Brussels, Belgium
7 Erasme Hospital,Université Libre de Bruxelles, Department of Orthopaedics and Traumatology, Brussels, Belgium

Introduction: The use of nonoperative treatment for idiopathic clubfoot is more frequent: the Ponseti cast technique and the French functional technique. But the effect of tenotomy was not clearly documented.

The aims were to assess the impact of Achilles’ tenotomy on kinematics, kinetics and pressure variables including a multi-segment foot model approach and to compare the effect of these both treatment .

Methods: Thirty two clubfeet and 17 healthy feet (mean 7.8 yrs and 9.6 yrs) were included. Tenotomies were performed on 23 clubfeet. Ponseti cast technique was applied on 14 clubfeet and French functional technique on 18 clubfeet.

Children were equipped with reflective markers on trunk, pelvis, thigh, shank, hindfoot, midfoot and on lateral and medial forefoot, recorded using an optoelectronic system and two force plates. Two pressure plates were positioned on the force plates and synchronized. Joint angles, planar angles, ankle kinetics parameters were analyzed during stance phase. Lateral and medial pressures were also included in statistical group comparison.

Results and Discussion:
Significant differences were observed between clubfeet and controls with an increased pelvis RoM , an increased knee flexion initial contact, increased knee flexion 20-45 range, an increased in-toing foot progression, a decreased dorsiflexion during swing, a decreased medial pressure and a decreased of ankle power.

Conclusions: Combining multi-segment foot kinematics, kinetics and pressure data opens new opportunities to improve our understanding of clubfoot patterns. For kinematics, significant differences were observed between clubfeet and controls with a significant effect of tenotomy. However, no differences were retrieved between Ponseti vs French techniques. For kinetics, ankle moment and power were also significantly different. Plantar pressure highlighted a significant difference between groups on the medial part of foot. Further development is needed to relate joint/planar foot angle analysis with pressure data to better cover the complexity of clubfoot multiplanar deformity

העלאת קובץ המאמר או המצגת

Robert Elbaum