Does Clubfoot Affect Sports Ability and Participation in Children?

Background: Patients and families of school children with unilateral corrected talipes equinovarus (TEV, idiopathic clubfoot) have anecdotally noted a difference in sporting function from the unaffected side to the clubfoot. The purpose of this study was to assess difference in strength, balance, performance, and patient perception of their sporting ability using contemporary sports research technology. Methods: Following Institutional Review Board approval, 27 unilateral Ponseti-treated patients with clubfoot (ages 8-15) enrolled in a cross-sectional study. Demographics and patient-reported outcomes (Patient Reported Outcomes Measurement Information System [PROMIS] and Oxford Ankle Foot Questionnaire for Children [OxAFQ-C]) were collected. Strength, range of motion, and functional mechanics were measured using dynamometry, markerless motion capture, and forceplates, respectively (VALD ForceFrame, HumanTrak, and ForceDecks). Comparisons between affected and unaffected limbs were conducted using paired Student's Results: Mean evaluation age was 11.2 years (30% male); mean initial Dimeglio score was 10.5. Most (78%) participated in >2 sports. PROMIS Physical Activity mean score was 52.3 (SD 6.6), and mean OxAFQ-C Physical score was 81.5 (SD 17.5). Comparing TEV and unaffected limbs in range of motion and strength found differences in ankle dorsiflexion force (mean 58.4N [SD 20.8] vs. 68.6N [28.1]; p = 0.02) and lateral spine tilt during lunge stance (-0.2° [2.6] vs. -1.5° [2.4]); p = 0.04). No significant differences were noted with most performance measures, with small differences noted in single leg stand on the clubfoot limb (1005 mm vs. 781 mm), and mean velocity (67 mm/s vs. 52 mm/s; p < 0.001), jump height (1.6 in vs. 2.2 in; p < 0.001), and peak power (749W vs. 808W; p = 0.02). Conclusions: Children with unilateral TEV report favorably on standardized reports of patient-reported and functional assessments including sports participation. Although differences were noted with decreased balance with flexibility, single leg stance, and jump height on the clubfoot limb, overall, the magnitude of these differences was generally small, and their clinical significance remains uncertain given the lack of established minimal clinically important differences (MCIDs) for this population. Level of Evidence: Prognostic Level IV (cross-sectional, small sample size). See Instructions for Authors for a complete description of levels of evidence.