Aim: This study was designed to investigate the association between clinical assessment International Clubfoot Study Group (ICFSG) and quantitative gait data of the children

Methods: Nineteen patients with 30 surgically treated clubfoot were included in this study. Bilateral involvement was present in 11. Average age was 9 years (range 6–14 years) at the time of last follow-up. Patients were treated with different surgical techniques at early childhood period. At the final follow-up they were evaluated according to ICFSG clinical scale. This rating system is based on three main subgroups of evaluation as morphologic evaluation, functional evaluation and radiological evaluation. The maximum score is 12 in morphologic evaluation, 36 in functional evaluation and 12 in radiological evaluation. The total score is from 0 for a perfect result to 60 for the worst result. Further, a total score of 0–5 is rated as excellent, 6–15 as good, 16–30 as fair and over 30 as poor. Quantitative gait data was collected with the Vicon 370 (Oxford Metrics, Oxford, UK). Two force plates (Bertec, Colombus, Ohio, USA) were used for kinetic analysis. All time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee and ankle in sagittal, coronal and transverse planes) and kinetic (ground reaction forces, moments and powers of hip, knee and ankle) data were processed using Vicon Clinical Manager software package. Spearman correlation analysis was used to evaluate if there is a correlation between total clinical score and gait parameters.

Results: Average ICSG score was 8.63 (range 1–29). Outcome was excellent in 16, good in 8 and fair in 6 patients according to ICSG. There was a significant correlation between total ICSG score and walking velocity (rs=−0.195, p=0.004), step length (rs=−0.476, p=0.019), pelvic excursion in sagittal plane (rs=−0.429, p=0.026), hip excursion in sagittal plane (rs=−0.511, p=0.006), knee excursion in sagittal plane (rs=−0.486, p=0.019), Ankle excursion in sagital plane (rs=−0.413, p=0.040), peak ankle plantar flexion moment (rs=−0.600, p=0.039), peak ankle plantar flexion power (rs=−0.487, p=0.025). When we compare the gait parameters between groups only foot progression angle showed a significant difference (p=0.031).

Conclusion: ICFSG score is a successful method to follow outcome in patients with surgically treated clubfoot. ICFSG score is correlated with many kinematic and kinetic gait data however foot progression angle is the only parameter predicting outcome in children with surgically treated idiopathic clubfoot. Quantitative gait analysis may help to define the liable factors of the functional deficits, and to prescribe novel rehabilitation techniques to enable better outcome for children with clubfeet.

Aim: Surgical treatment for idiopathic clubfeet aims to realign the foot and allow plantigrade weight bearing with adequate joint motion. In spite of satisfying clinical and radiological results for both the physician and the parents shortly after the operation, deterioration may occur years after the surgery. The aim of this study was to evaluate gait characteristics of children with surgically treated unilateral clubfoot and had good clinical outcome.

Methods: Twelve children (mean age 5.9±2.3 years (4–9)) with surgically treated unilateral clubfoot before age one and twelve age matched healthy children were included in the study. Foot length, calf circumference, ankle range of motion and radiographic measurements were recorded. Quantitative gait data was collected with the Vicon 370 (Oxford Metrics, Oxford, UK). Two force plates (Bertec, Colombus, Ohio, USA) were used for kinetic analysis. All time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee and ankle in sagittal, coronal and transverse planes) and kinetic (ground reaction forces, moments and powers of hip, knee and ankle) data were processed using Vicon Clinical Manager software package.

Results: Foot length of the operated side was shorter than the unaffected side but the difference was not significant (p> 0.05). Calf circumference and ankle range of motion were significantly less than the unaffected side (p< 0.05). Quantitative gait data revealed that children with clubfoot had slower walking velocity (0.75±0.25 versus 1.02±0.18 m/sec, p=0.001), shorter stride length (0.72±0.23 versus 0.91±0.05 meters, p=0.001) and less ankle plantar flexor moment (0.73±0.22 versus 0.88±0.11 m/sec, p=0.007) than healthy children. Unaffected side showed increased pelvic excursions and medio-lateral ground reaction forces as well as decreased ankle and hip motion in sagittal plane.

Conclusion: We detect various deviations in gait parameters even in so called well treated patients according to radiological and clinical criteria. Alterations in the unaffected foot may be the result of the subclinical involvement of the unaffected foot by disease as well as the compensatory mechanisms. These gait deviations may lead long-term morbidity later in adulthood.

Aim: To quantify the gait characteristics of the children with a history of treated femoral shaft fracture, and compare the outcome of three different treatment methods (spica cast, plate fixation, and flexible intramedullary nailing) in terms of kinematic and kinetic characteristics of gait.

Material and Methods: Fifteen children (9 boys, 8 girls), admitted to our hospital for unilateral (n=12) and bilateral (n=3) femoral fracture were evaluated in this study. The average age was 9.4 years (range 5–15 years). They were treated by three different methods: spica cast (n=5 ), plate fixation (n= 5), flexible intra-medullary nailing (n= 5). The cases were followed up with an average period of 23 months (6–48 months). At the end of the follow up period quantitative gait analysis was performed using Vicon 370 system with five cameras and two Bertec force plates. For each assessment, a typical walk was selected for each limb on the basis of consistency of time-distance characteristics. Kinematic and kinetic gait characteristics were compared using MANOVA, post hoc Tukey and LSD tests.

Results: Gait characteristics of the patients were significantly different than normal, however, the difference between spica cast, plate fixation, and flexible intra-medullary nailing groups in terms of kinematic and kinetic characteristics of gait were not statistically significant. Older children treated by spica cast showed the best gait characteristics among the others.

Conclusion: Femoral shaft fractures during childhood causes significant deviations of gait characteristics even though treated by spica cast, plate fixation, or flexible intra-medullary nailing. These children need novel treatment options to prevent gait pathologies, and further evaluation to understand the compensatory mechanisms of gait deviations.