Subjective and Objective Outcome in Congenital Clubfoot; a Comparative Study of 204 Children

David Chesney; Simon Barker; Nicola Maffulli

Disclosures

BMC Musculoskelet Disord 

In This Article

Abstract and Background

Abstract

Background: Outcome following management of congenital talipes equinovarus (clubfoot) can be assessed in a number of ways. Bjonness stated simply that "the patient is the final judge of whether he has a good foot"; a purely subjective assessment. Others have employed objective measures. Combining subjective evaluation with a more objective assessment of movement and position of the foot, is likely to give a more comprehensive picture of the final result of clubfoot. The purpose of this study was to compare subjective and objective outcome following management of clubfoot, and evaluate sex differences in outcome.
Methods: We used a patient-administered subjective assessment of outcome following treatment of clubfoot and compared it with objective anthropometry and range of movement of the ankle to assess and compare subjective and objective outcome in clubfoot. Statistical analysis was performed using Pearson correlation coefficients. Significance was tested using Student's t-test test.
Results: Objective outcome can be assessed using length of the foot, calf circumference and range of movement at the ankle. These are easy to measure, reproducible, and correlate well with subjective outcome. Objective outcome is comparable for boys and girls. However, subjectively, female patients and their parents are less happy with the results of management of clubfoot.
Conclusion: There is a correlation between the anthropometric measures and the subjective outcome and an objective grading can be designed using foot length, calf muscle bulk and range of movement at the ankle.

Background

Although some authors believe that patients themselves are the ultimate judges of whether they have a 'good foot,[1,2,3,4] the need to evaluate outcome of management of clubfoot has traditionally employed objective measures.[3] Combining subjective evaluation of cosmetic acceptability with a more objective assessment of movement and position of the foot is likely to give a more comprehensive picture of the final result of clubfoot.

Objective measures to assess outcome include; range of movement at the ankle,[3] leg and foot muscle strength,[4] pressure distribution under the sole of the foot,[5] calf circumference, gait,[6] skinfold thickness, foot length, foot width,[7] and shoe size.[8] Radiographic assessment has also been advocated by some, with a number of measurements reported,[9] although the use of radiographs is not universally accepted.

As far as we are aware, comparison of objective and subjective measures has, however, not been performed, hence the correlation between the two is unknown. We employed a simple patient-administered subjective assessment compared to an objective assessment using anthropometry and ankle range of movement to compare subjective and objective outcome in clubfoot.

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