Do Ponseti plasters delay gross motor milestones of South African children treated for idiopathic clubfeet?

Abstract

INTRODUCTION: The Ponseti method for the treatment of idiopathic club foot is the gold standard of treatment in South Africa. A study in New York reviewed attainment of eight gross motor milestones in these children and found that independent ambulation was delayed on average by 2 months compared to unaffected children. 

METHODS: A retrospective review of gross motor milestones was performed in patients treated at a South African clubfoot clinic. All patients were ambulating independently at review and ages at attainment of three motor milestones were recorded (sitting, crawling and walking independently). The World Health Organisation (WHO) published the normal range for achievement of these milestones in six regions across the world. We compared the results of our patients to the 50th percentile in that study. 

RESULTS: Results show that patients in our study sat at a mean of 5.8 (standard deviation ± 1.3) months and crawled at a mean of 8.3 (SD ± 1.7) months, both equal to the WHO 50th centiles for unaffected children. Independent walking, however, was achieved at a mean of 15.3 (SD ± 2.3) months which is statistically significantly different to the 50th centile for unaffected children in the WHO study (p<0.05). In our study, 86% of children achieved independent walking within 18 months. No statistical difference was found between unilateral and bilateral cases. 

CONCLUSION: Children treated for idiopathic clubfoot (unilateral or bilateral) can expect no delays in sitting or crawling. Minimal delays in achieving independent walking of about three months can be expected with an 86% chance of walking within the accepted normal range for unaffected children.