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Objective differences in the feet of
children with CTEV requiring a TATT
Kelly Gray, Paul Gibbons, David Little
& Joshua Burns
Department of Orthopaedic Surgery
The Children’s Hospital at Westmead
Sydney, Australia
Methods
Children with CTEV (2-6 yrs)
Compliant with the Ponseti technique
Objectively assess:
• Those who require a TATT (n=20)
• Those who do not require a TATT (n=12)
Objective measures
• Range of movement
• Standing foot posture
• Strength
• Stance phase gait
Dimeglio Scale
Dimeglio Scale
Foot Posture Index
Supination Neutral Pronation
-12 +12
Redmond A, 1998, The Foot Posture Index
Foot Posture Index
Normal values provided by A/Professor Joshua Burns, CMT data
-4
-2
0
2
4
6
8
Normals Controls Surgical
Sup
inat
ed
Pro
nat
ed
Foot Posture Index
-4
-2
0
2
4
6
8
Normals Controls Surgical
Sup
inat
ed
Pro
nat
ed
Foot Posture Index
-4
-2
0
2
4
6
8
Normals Controls Surgical
Sup
inat
ed
Pro
nat
ed
Hand Held Dynamometry
Photo provided by Dr Kristy Rose
Strength
0
20
40
60
80
100
120
140
160
180
Inversion Eversion Dorsiflexion Plantarflexion
Control gp (n=12)
Surgical gp (n=20)
Normal (n=10)
Strength
0
20
40
60
80
100
120
140
160
180
Inversion Eversion Dorsiflexion Plantarflexion
Control gp (n=12)
Surgical gp (n=20)
Normal (n=10)
Strength
0
20
40
60
80
100
120
140
160
180
Inversion Eversion Dorsiflexion Plantarflexion
Control gp (n=12)
Surgical gp (n=20)
Normal (n=10)
Pedobarography
Pedobarography
Contact Area
Forefoot
Medial
p= 0.001
Lateral
Midfoot
Medial
p< 0.001
Lateral
Hindfoot
Medial
p=0.033
Lateral
Contact Time
Forefoot
Medial
Lateral
p= 0.034
Midfoot
Medial
Lateral
p= 0.004
Hindfoot
Medial
p= 0.001
Lateral
p= 0.001
Pressure Time Integral
Forefoot
Medial
Lateral
Midfoot
Medial
Lateral
p= 0.034
Hindfoot
Medial
p= 0.027
Lateral
p= 0.010
Conclusions
• Measurable objective differences in children who require a tendon transfer
• Re-Assess post surgery
THANK YOU
Function and Quality of Life