Comparison of serial casting and stretching technique in children with congenital idiopathic clubfoot: Evaluation of a new assessment system

Figures & data

Figure 1. Summary of treatment interventions and assessment points.

Figure 2. Splint made of Plexidur, which can be remolded as the foot is successively corrected by the stretching and manipulation treatment.

Figure 3. The dynamic Knee Ankle Foot Orthosis (KAFO, with permission from Scandinavian Orthopaedic Technical Laboratory).

Table 1.  A summary of the Clubfoot Assessment Protocol (CAP)

Subgroup	Items	Scores (Worst to best)
Mobility I	Ankle dorsal extension	Item level: 0, 1, 2, 3 and 4
	Ankle plantar flexion	(Total sub score: 0–20)
	Heel varus/valgus
	Eversion/inversion
	Forefoot adduction/abduction
Mobility II	Length of toe flexors:	Item: 0, 2 and 4.
	M. flexor digitorum longus	(Total sub score: 0–8)
	M flexor hallucis longus
Muscle function	Strength of footeversion:	Item: 0, 2 and 4.
	M. peronus longus	(Totalsub score: 0–8)
	M.extensor digiti longus
Morphology	Tibial torsion	Item: 0, 2 and 4.
	Heel position	(Total sub score: 0–16)
	Forefoot position
	Cavus or planus
Motion quality I	Walking	Item:0, 1, 2, 3 and 4.
	Running	(Total sub score: 0–16)
	Toe walking
	Heel walking
Motion quality II	One-leg balance	Item:0, 1, 2, 3 and 4.
	One-leg hop	(Total sub score: 0–8)

0 = cannot or ++ poor, 1= very deviant or + poor, 2 = deviant or poor, 3 = slightly deviant or slightly poor and 4 = within normal.

Table 2.  A summary of the Dimeglio classification scoring system

Items	Scores (worst to best)
Equinus	4, 3, 2, 1, and 0
Varus	4, 3, 2, 1, and 0
Supination	4, 3, 2, 1, and 0
Adductus	4, 3, 2, 1, and 0
Posterior crease	1 and 0 (yes/no)
Medial crease	1 and 0 (yes/no)
Cavus	1 and 0 (yes/no)
Deviant muscle function	1 and 0 (yes/no)
	Total score: 0–20

Table 3.  The median and 95 % confidence interval (CI) at five different assessment occasions for the Ponseti casting technique group (PCT) and Copenhagen stretchning treatment group (CPH)

	Newborn baseline	1 month	2 months, preoperative	p-value^bnewborn vs 2 months	4 months, postoperative	p-value^b2 months vs 4 months	2 years	p-value^b4 months vs 2 years
CAP  Mobility I
PCT	40	80	85	<0.01	95	<0.01	95	0.03
	(35–45)	(75–85)	(80–90)		(95–95)		(95–100)
CPH	45	67.5	77.5	<0.01	95	<0.01	92.5	0.8
	(35–45)	(60–80)	(70–90)		(90–95)		(90 -95)
p-value^a	0.7	0.02	0.1		0.4		0.008
CAP Mobility II
PCT	50	100	100	<0.01	100	0.56	100	0.2
	(50–75)	(75–100)	(100–100)		(100–100)		(100–100)
CPH	100	100	100	0.2	100	0.05	100	0.2
	(50–100)	(75–100)	(75–100)		(100–100)		(100–100)
p-value^a	0.03	0.6	0.02		1		0.28
CAP Muscle function
PCT	50	75	100	<0.01	100	0.41	100	0.5
	(50 -75)	(75–100)	(100–100)		(100–100)		(100–100)
CPH	50	75	93.8	<0.01	100	0.25	100	0.04
	(50–75)	(75–100)	(62.5–100)		(75–100)		(100–100)
p-value^a	0.9	0.1	0.05		0.5		1
CAP Morphology
PCT	62.5	100	100	<0.01	100	0.73	100	0.05
	(62.5–75)	(87.5–100)	(100–100)		(100–100)		(87.5–100)
CPH	62.5	75	87.5	<0.01	100	0.05	87.5	0.02
	(50–75)	(75–87.5)	(75–100)		(100–100)		(87.5–100)
p-value^a	0.7	0.001	0.05		0.8		0.4
CAP Motion-quality
PCT	n.a.	n.a.	n.a.		n.a.		100	n.a
							(87.5–100)
CPH							75	n.a
							(62.5–87.5)
p-value^a							0.03
DCS
PCT	50	75	75	<0.01	85	<0.01	90	<0.01
	(50–55)	(65–75)	(70–80)		(80–85)		(90–90)
CPH	50	70	75	<0.01	85	<0.01	90	<0.01
	(50–55)	(60–75)	(65–80)		(80–85)		(90–90)
p-value^a	0.8	0.2	0.7		0.9		0.2

^aMann-Whitney U test.

^bWilcoxon Signed Rank test.

n.a = not applicable.