Follow-up of children with congenital clubfoot. Development of a new evaluation instrument.

Research output: ThesisDoctoral Thesis (compilation)


Clubfoot is a congenital disorder, affecting about one of 1000 children. Treatment consists of initial correction of the deformity, followed by prolonged orthosis treatment to maintain the correction obtained. There are several different treatment options. Outcome studies, using reliable and valid instruments are rare.

In this thesis an assessment instrument, Clubfoot Assessment Protocol (CAP) was developed for longitudinal follow up of children with clubfoot. The CAP provides information on the development of different functional domains (mobility, muscle function, morphology and motion quality) over time. The reliability, validity, responsiveness and clinical utility was analysed in a prospective sample of 73 consecutive children. The clinical utility was analysed by comparing Ponseti casting technique vs Copenhagen stretching method and by studying developmental motor problems in children born with clubfoot.

The methodological studies showed that the CAP can be used with sufficient reliability and validity. For research purposes, experience of the CAP and data on actual inter observer differences should be described. The CAP showed a stronger ability to discriminate foot status than the Dimeglio Classification system (DCS). The CAP is more sensitive to change especially in the moderate to severe range. Thus, the CAP is an important contribution to clubfoot evaluation in clinical and in research settings.

The casting technique according to Ponseti was superior in clubfoot correction regarding mobility and motion quality according to the CAP at age two years. Furthermore, less surgery was needed. The orthosis management showed maintenance or slight improvement of the clinical status along with good compliance.

Developmental motor ability problems were found more often than expected among seven year old children treated for idiopathic clubfoot. This finding could not be explained by previous surgery or foot function. The ability to stand on one leg correlated strongest to motor problems and could serve as a screening test in clinical settings of clubfoot evaluation.


  • Hanneke Andriesse
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Physiotherapy


  • Validity, Assessment instrument, Clubfoot, Reliability, Responsivenss, Treatment evaluation, Developmental motor ability, Skeleton, rheumatology locomotion, muscle system, muskelsystem, Skelett, Surgery, reumatologi, traumatologi, Rehabilitering (medicinsk och social), rehabilitation, revalidation, kinesitherapy, Physical medicine, orthopaedics, traumatology, Kirurgi, ortopedi
Original languageEnglish
Awarding Institution
Supervisors/Assistant supervisor
Award date2007 Sep 14
  • Institution for Health Sciences, Division of Physiotherapy, Lund University Department of Orthopaedics, Lund University Hospital
Print ISBNs978-91-85897-01-8
Publication statusPublished - 2007
Publication categoryResearch

Bibliographic note

Defence details Date: 2007-09-14 Time: 09:00 Place: Segerfalksalen, BMC, Universitetssjukhuset, Lund. External reviewer(s) Name: Haglund-Åkerlind, Yvonne Title: docent Affiliation: Astrid Lindgrens Barnsjukhus, Stockholm --- The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Division of Physiotherapy (Closed 2012) (013042000)

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Related research output

Hanneke Andriesse, Ewa Roos, Gunnar Hägglund & Gun-Britt Jarnlo, 2006, In: BMC Musculoskeletal Disorders. 7, 28

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