O3237: Sports Participation Among Children and Adolescents Following Ponseti Treatment for Idiopathic Clubfoot

Background: Idiopathic clubfoot is a common, complex congenital foot and ankle anomaly. The Ponseti casting method is an effective and widely accepted treatment modality consisting of a series of casts followed by an Achilles tenotomy to reposition the foot into neutral alignment. While effective, patients treated with Ponseti technique do continue to report some pain, weakness, and decreased range of motion at long-term follow up. Most children with idiopathic clubfoot have similar gross motor function and activity level in childhood compared to peers without clubfoot. However, data on sports participation later in childhood for those undergoing Ponseti treatment is lacking. Our objective was to describe the prevalence of organized sports participation among children and adolescents who have undergone Ponseti treatment for idiopathic clubfoot.

Methods: We surveyed parents of patients aged 5 to 17 years with a diagnosis of idiopathic clubfoot who were treated with Ponseti technique during infancy. Parents were asked to complete a one-time REDCap survey which included basic demographic questions, two validated activity scores (PACE+ and PROMIS Physical Activity (PA) 8a sF V1.0), and questions relating to sports participation. A control cohort was composed of the siblings of clubfoot patients.

Results: Seventy patients with clubfoot and 18 siblings without clubfoot were included. In the clubfoot group, 48 (68.6%) were male and 11 (61.1%) were male in the sibling group (p=0.74). PROMIS t-scores were 52.5 ± 7.4 vs. 55.7 ± 7.1 in the clubfoot and sibling groups, respectively (p=0.09). PACE+ scores were lower in the clubfoot group (3.4 ± 2.0) compared to the sibling group (4.3 ± 1.8, p=0.08). Regarding sports participation, 54 (77.1%) of the clubfoot group and 18 (100%) of the sibling group have participated in sports. Basketball (42.6%), soccer (40.7%), and baseball (37.0%) were most played among the clubfoot group. Similarly, among siblings, soccer (55.6%), basketball (44.4%), baseball (27.8%) and swimming (27.8%) were most common (Graph 1). Among clubfoot patients participating in sports 8 parents (14.8%) reported clubfoot had stopped their child from participating in specific sports; difficulty keeping up with peers was a common reason for limitations (n=3, 5.6%).

Conclusion: This is one of the first studies to report sports participation among patients treated with Ponseti technique for idiopathic clubfoot. This data suggests that these patients are active in sports. The clubfoot group had excellent physical activity scores, above the 50th percentile for PROMIS-PA. Differences with activity and sports participation are suggested with lower validated activity scores, withdrawal from sport due to pain, and difficulty keeping up with peers recorded among patients with clubfoot. Further studies looking at sports participation and potential injury prevalence are necessary to better understand long-term clinical and functional outcomes in patients treated with Ponseti technique for idiopathic clubfoot.