Idiopathic congenital clubfoot can be treated either operatively (comprehensive surgical release (CSR)) or conservatively (ponseti technique (PCT)). This thesis compared the mid-term outcomes after CSR and PCT treatments to a typically developing sample. A Dynamical Systems Analysis (DSA) approach and a multi-segment foot model were used to examine group differences in multi-segment foot and lower extremity kinematics, kinetics, coordination and coordination variability during walking. Ten children with clubfoot treated with PCT and seven children with clubfoot treated with CSR were evaluated retrospectively and compared to ten typically developing children. Multi-segment foot and lower extremity kinematic (240 Hz) and kinetic (1080 Hz) data were collected while participants walked barefoot at a fixed walking velocity (1.0 m/s-1 ±5%). Sagittal plane metatarsophalangeal (MTP) and three-dimensional (3D) forefoot-rearfoot, ankle, knee and hip joint range of motion (ROM) during stance and 3D ankle, knee and hip peak joint moments during push-off were calculated. A modified vector coding technique was used to quantify the multi-segment foot and lower extremity coordination and coordination variability throughout stance for forefoot-rearfoot inversion/eversion (Ff-Rf), rearfoot inversion/eversion–tibial internal/external rotation (Rf-Tib) and femur-tibia internal/external rotation (Fem-Tib) couples. Reduced MTP and forefoot-rearfoot ROM was observed in the CSR group while the PCT group demonstrated values comparable to CTR. Sagittal plane ankle ROM was similar between groups however, the CSR group demonstrated reduced frontal plane ROM compared to PCT. Peak ankle plantar flexion moment was reduced in the last 50% of stance in the clubfoot groups. The CSR group demonstrated greater knee and hip moments compared to CTR and PCT. The PCT group demonstrated lessor peak ankle eversion, knee external rotation and knee valgus moments compared to CTR. No significant differences were observed in Ff-Rf, Rf-Tib and Fem-Tib coordination and coordination variability throughout stance between the groups. PCT and CSR gait was characterized by restricted multi-segment foot motion and abnormal lower extremity joint moments; suggesting mild residual deformity. Despite residual deformity, the coordination and coordination variability results indicate that the PCT and CSR groups are not functionally limited and demonstrate similar multi-segment foot and lower extremity movement patterns as CTR.
| Identifer | oai:union.ndltd.org:UMASS/oai:scholarworks.umass.edu:masters_theses_2-1321 |
| Date | 23 November 2015 |
| Creators | Whited, Amy |
| Publisher | ScholarWorks@UMass Amherst |
| Source Sets | University of Massachusetts, Amherst |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | Masters Theses |
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