Plantar pressures in children with congenital talipes equino varus-A comparison between surgical management and the Ponseti technique

- Pedobarographic analysis provides added value regarding foot functionality.
- Increased pressure under the lateral midfoot suggests a degree of undercorrection in the Ponseti group.
- Increased force at the medial midfoot in the surgical group suggests some degree of overcorrection in the surgical group.

The Ponseti technique for treatment for Congenital Talipes Equinovarus (CTEV) was introduced in the authors' institution in 2001, substituting a more traditional orthopaedic approach which involved surgery. There is currently limited published information regarding the differences in clinical outcomes between these two techniques, particularly in relation to plantar pressure analysis. This study aims to determine differences in pedobarographic outcome in children with CTEV, treated with either a surgical or Ponseti approach.A high resolution pedobarograph was used to record plantar pressure distribution in 52 children with CTEV and 26 children with typical development. Data were imported into Matlab where a custom programme was developed for processing and analysing pedobarographic recordings.There were significant differences in both treatment groups compared to the typically developed group (p < 0.05) for most measurements. The most salient differences between treatment groups were (i) at the hind-foot where the Ponseti group had significantly lower maximum peak pressures (p < 0.05); (ii) at the lateral mid-foot where children treated by the Ponseti approach showed significantly larger peak force (p < 0.001), average peak pressure (p < 0.001) and maximum peak pressure (p < 0.01); (iii) at the lateral fore-foot where the surgical group showed lower average peak pressure (p < 0.05); and (iv) in the medial/lateral fore-foot ratio where the Ponseti group showed significantly lower values (p < 0.05).Plantar pressure analysis is a complementary measurement for the assessment of gait in children with CTEV. Data presented in this study showed that while there were deviations in children with CTEV, the differences observed between treatment groups suggest children in the Ponseti group have some level of under correction or recurrence.