Factors influencing the late recurrence of clubfoot in children (5-10)
Research type
Research Study
Full title
‘An investigation of the modifiable factors influencing the late recurrence of talipes equinovarus post Ponseti treatment in children aged 5-10 years'.
IRAS ID
255152
Contact name
Nick Dobbin
Contact email
Duration of Study in the UK
1 years, 0 months, 7 days
Research summary
Research Summary
Talipes equinovarus, commonly known as ‘clubfoot’ is the most common congenital orthopaedic anomaly and one of the leading causes of disability in children (Abdullah, 2016). The condition is characterised by an abnormal bony development of the foetal skeleton. The foot points downwards and is turned inwards (Ošt’ádal et al., 2014). The deformity has a high response rate to initial conservative treatment of serial plasters and orthotic bracing, known as the Ponseti method (Ponseti and Campos, 2009). Occasionally further soft tissue surgery is required in children aged under five years,to complete the foot correction. However, the idiopathic nature of the condition means that there is a tendency for the original deformity to reoccur/relapse in part or in full (Tuinsma et al.,2018). At six years of age,the probability of recurrence lies at 29%(O'Shea and Sabatini. 2016). Therefore, despite initial promising treatment there is a relatively high rate of recurrence. Because the aetiology of clubfoot remains unknown for a large percentage of these children, it is difficult to identify risk factors associated with recurrence (Moon et al 2014). Regrettably, the satisfactory treatment of relapsed feet remains obscure (Chand et al., 2018). The aim of the research is to ‘define the musculoskeletal and movement characteristics of talipes equinovarus (CTEV) (known as ‘clubfoot’) in children aged 5-10yrs. post Ponseti treatment and provide insight into the potential modifiable reasons for relapse’. This is a PhD single centre study, which involves the clubfoot clinic at Manchester Children’s hospital, (MCH, 2ndry care centre) and the movement laboratory facilities at Manchester Metropolitan University. The research includes the participation of three groups of children aged between 5-10yrs. who differ in the variable of interest e.g., clubfoot relapses, non-relapses and aged matched control. All three groups will undergo calf muscle evaluation of strength, length, volume and stiffness.Summary of Results
This study, titled ‘an investigation of the modifiable factors influencing the late recurrence of clubfoot following Ponseti treatment in children aged 5 to 10 years’, was led by Glenis Donaldson in collaboration with the Clubfoot Clinic at Manchester Children’s Hospital. Manchester Metropolitan University acted as the research sponsor. This work was supervised by Dr Nick Dobbin and Ms Naomi Davis. The study took place between January 2022 and March 2025.Clubfoot is a condition where a child’s foot points downwards and inwards. Although treatment using the Ponseti method is usually very successful, some children experience a return of the condition later in childhood. The reasons for this are not well understood. Treatments for recurrence can include further casting or surgery, which do not always lead to good long-term movement or comfort. Understanding factors that may influence recurrence could help improve rehabilitation and reduce the need for further treatment.
The aim of this study was to examine muscle structure, strength, and walking patterns in children aged 5 to 10 years, with particular focus on children who developed a recurrence that affected ankle movement. Forty-three children volunteered for the study, and thirty-nine were included in the final analysis. These included children with recurrence, children with clubfoot but no recurrence, and children without clubfoot.
Children attended a testing session lasting up to four hours. The assessments included a clinical foot examination, tests of calf muscle strength, measurements of the Achilles tendon, which connects the calf muscle to the heel, walking assessments, and scans of the calf muscles. This data was then analysed to compare the three groups.
A total of 39 children were included in the study. Not all the children completed all parts of the assessments. The results showed that children with clubfoot had smaller and stiffer calf muscles, with a higher amount of non-muscle tissue, compared to children without clubfoot. These features were present in both clubfoot groups, with only small differences between children with and without recurrence. During walking, children with clubfoot showed reduced ankle movement, calf muscle strength, and ability to push off the ground when walking, with the greatest difficulties seen in the recurrence group.
Understanding these differences may help clinicians develop rehabilitation approaches that improve strength and movement and reduce the need for further treatment or surgery. The findings also suggest that reduced muscle strength and movement may contribute to the risk of recurrence. External factors such as levels of daily physical activity may also play a role and could represent a factor that can be changed through rehabilitation.
This study adds to understanding of why clubfoot may recur as children grow. Further research will focus on identifying the most appropriate type and amount of exercise or physical activity that may help support muscle development and reduce the risk of recurrence as children grow.
REC name
Wales REC 4
REC reference
20/WA/0326
Date of REC Opinion
10 Dec 2020
REC opinion
Favourable Opinion