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