BS Richards

KA Jeans

Kelly A Jeans

Kirsten Tulchin

Lindsey Crawford

Lori A Karol

English

PubMed

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Journal of Foot and Ankle Research

Plantar pressures and ankle kinematics following anterior tibialis tendon transfers in children with clubfoot

Springer - Publisher Connector

ORAL PRESENTATION Open Access
Plantar pressures and ankle kinematics following
anterior tibialis tendon transfers in children with
clubfoot
Kirsten Tulchin1*, Kelly A Jeans1, Lori A Karol1, Lindsey Crawford2
From 3rd Congress of the International Foot and Ankle Biomechanics Community
Sydney, Australia. 11-13 April 2012
Background
Relapses following nonoperative treatment for clubfoot
occur in 29-37% of feet following initial correction [1].
In patients with residual clubfoot deformity, excessive
medial pull of the anterior tibialis muscle can lead to
persistent supination and inversion of the forefoot [1].
The purpose of this study was to assess kinematic and
plantar pressure changes following an ATT transfer.
Materials and methods
Thirty children (37 feet) were evaluated pre- and 2.0
±0.6 yrs (range: 0.8 to 2.9) post-op following ATT
transfer. Foot progression angle (FPA) and sagittal
ankle kinematics were assessed using a VICON sys-
tem. Plantar pressures were collected using the Emed
ST Platform. Representative trials were chosen for
each subject for gait and plantar pressures. Plantar
pressures were divided into medial and lateral hind-
foot, midfoot and forefoot. Variables included: contact
time (CT%), contact area (CA% total), peak pressure
(PP), hindfoot-forefoot angle [2], deviation of the cen-
ter-of-pressure (COP) line and region of initial con-
tact. Twenty age matched controls were used for
comparison.
* Correspondence: kirsten.tulchin@tsrh.org
1Texas Scottish Rite Hospital for Children, Dallas, Texas, 75219, USA
Full list of author information is available at the end of the article
Table 1 Plantar pressures comparing Pre-Op, Post-Op & Control
Forefoot Midfoot Forefoot
Medial Lateral Medial Lateral 1st Met. 2nd Met. 3-5th Mets.
Mean +SD Mean +SD Mean +SD Mean +SD Mean +SD Mean +SD Mean +SD
Peak Pressure <0.0001 ‡*† <0.0001 ‡*† 0.0001 ‡* <0.0001 ‡* <0.0001 ‡* <0.0001 ‡* <0.0001 ‡*
Pre 10.2 6.6 10.6 4.8 4.4 2.6 16.2 6.3 4.4 2.6 9.1 3.7 23.8 10.3
Post 17.2 11.4 15.4 7.1 6.5 3.2 10.0 3.3 6.5 3.2 12.4 4.6 16.0 4.0
Control 25.0 8.2 20.8 6.4 7.5 2.0 7.9 1.8 7.5 2.0 14.7 4.9 14.5 4.7
Contact Area% 0.0011 ‡ 0.3299 0.0012 ‡ <0.0001 ‡*† <0.0001 ‡*† 0.5241 <0.0001 ‡*†
Pre 9.1 3.4 13.2 4.8 2.1 2.1 24.8 2.9 2.1 2.1 8.4 2.3 26.6 5.2
Post 10.4 2.3 12.7 2.7 3.8 3.6 20.6 2.6 3.8 3.6 8.4 1.2 22.6 4.8
Control 11.8 1.1 11.7 1.0 5.2 3.4 16.0 2.7 5.2 3.4 8.9 1.5 17.8 2.5
Contact Time% 0.0011 ‡* 0.0408 0.0026 ‡* <0.0001 ‡† <0.0001 ‡* 0.0006 * <0.0001 ‡*†
Pre 38.8 21.9 48.2 18.9 31.6 22.7 80.3 8.0 31.6 22.7 75.7 15.1 94.5 3.5
Post 54.4 17.1 57.2 15.0 47.2 20.9 74.6 9.5 47.2 20.9 86.9 10.7 90.9 5.1
Control 50.7 9.0 49.9 8.5 45.2 9.2 61.8 10.8 45.2 9.2 82.0 6.3 83.9 5.0
Significant change (p< 0.05): ‡Pre/Control; †Post/Control; *Pre/Post
Tulchin et al. Journal of Foot and Ankle Research 2012, 5(Suppl 1):O32
http://www.jfootankleres.com/content/5/S1/O32
JOURNAL OF FOOT
AND ANKLE RESEARCH
© 2012 Tulchin et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Results
Changes in plantar measures in the hindfoot show nor-
malization of the CA% and CT% post-op (Table 1). The
forefoot shows the most change with a significant
decrease in CA%, CT% and PP in the lateral forefoot,
redistributed to the first metatarsal for more even distri-
bution through the foot. Initial contact was not different
from normal post-op and no change was seen in the
deviation of the COP line or hindfoot-forefoot angle
(p=0.8025) post-op. Kinematically, patients with greater
than 5° internal FPA had a higher likelihood of a suc-
cessful outcome (60% had a less internal FPA, while no
feet worsened.) Those that demonstrated a normal FPA
pre-op risked a worsening FPA (35% had a more inter-
nal FPA while only 12% improved.) There were 16/37
(43%) feet with foot drop in late swing pre-op, 10 of
which improved following surgery, however, 5 new foot
drops developed post-op.
Conclusions
Changes seen in plantar pressures would suggest that
during stance, the foot is better aligned, more evenly
distributing pressures throughout the foot rather than
focused to the lateral midfoot and forefoot regions.
Based on gait results, pre-operative foot progression
angle may be an indicator for successful outcomes of
ATT transfer in patients with residual deformity.
Author details
1Texas Scottish Rite Hospital for Children, Dallas, Texas, 75219, USA. 2John
Peter Smith Hospital, Fort Worth, Texas, 76104, USA.
Published: 10 April 2012
References
1. Richards BS, et al: A comparison of two nonoperative methods of
idiopathic clubfoot correction: the Ponseti method and the French
functional (physiotherapy) method. J Bone Joint Surg Am 2008,
90:2313-2321.
2. Jeans KA, Karol LA: Plantar pressures following Ponseti and French
physiotherapy methods for clubfoot. J Pediatr Orthop 2010, 30:82-89.
doi:10.1186/1757-1146-5-S1-O32
Cite this article as: Tulchin et al.: Plantar pressures and ankle kinematics
following anterior tibialis tendon transfers in children with clubfoot.
Journal of Foot and Ankle Research 2012 5(Suppl 1):O32.
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Tulchin et al. Journal of Foot and Ankle Research 2012, 5(Suppl 1):O32
http://www.jfootankleres.com/content/5/S1/O32
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Tulchin Kirsten

Jeans Kelly A

Karol Lori A

Crawford Lindsey

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A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method. J Bone Joint Surg Am

Plantar pressures following Ponseti and French physiotherapy methods for clubfoot. J Pediatr Orthop

Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges • Immediate publication on acceptance

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Plantar pressures and ankle kinematics following anterior tibialis tendon transfers in children with clubfoot

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