SLR - April 2010 - Janet Baatile
Reference:
Wallander, H., MD, Larson,S., MD, PhD, Bjoness,T., MD, PhD, Hansson, G., MD, PhD (2009). Patient reported outcome at 62 to 67 years of age in 83 patients treated for Congenital Clubfoot. Journal of Bone and Joint Surgery (British), 91, 1316-1321.
Scientific Literature Reviews
Reviewed by: Janet Baatile, DPM
Residency Program: Botsford Hospital, Farmington Hills, MI
Podiatric Relevance:
This is a Level III retrospective and prospective trial that evaluated quality of life and function of 83 patients (121 feet) with congenital talipes equinovarus (CTEV). The purpose of this study was to capture the long term outcome in regards to residual deformity, relapse, and inadequate function.
Methods:
The chart review was conducted out of two hospitals located in Gothenburg and Helsingborg in Southern Sweden. Charts of patients born with CTEV between 1940-1944 (total of 106 patients) were selected for review. This study was a a follow-up to a prior study conducted by Bjoness et. al in 1974. Eighty-nine patients were still alive in 2006 and were invited to participate, however 83 agreed to the trial. The male to female ratio was 63:20 and the lateralityof the deformity was 45 unilateral: 38 bilateral. Only 15 feet were treated non-surgically with serial casting. The mean number of operations was 2.1. All patients were asked to complete the following 3 questionnaires: the SF-36(short-form quality of life survey), the AAOS (American Academy of Orthopaedic Surgeons Foot and Ankle Questionnaire), and EQ-5D (health index value and a visual analog scale). Lastly, all patients were asked "Do you think your treated foot looks normal". The data was compared to the population norms from randomely selected age- and gender -matched normal group. The probability value was set at <0.05 for statistical significance.
Results:
For the SF-36, the male patients scored significantly better than the normal group as well as the female group for all eight domains. The male patients also scored significantly better for the EQ-5D when compared to the females. Both female and male participants scored worse than their corresponding matched groups for the AAOS questionnaire for the shoe comfort scale. Overall, the female participants reported difficulty with physical activity in their daily life. In addition, of the 39 patients that thought their feet had a normal appearance in 1974, 64% reported that they felt that their feet now had an abnormal appearance.
Conclusions:
The gender differences discovered regarding physical function and quality of life are not transparent. The authors speculated that maybe the males with CTEV adapted to their condition better than the females. It is also possible that the females may have had more severe deformities initially. No explanation was provided as to why the males with CTEV scored higher than their gender-matched norms for the SF-36 and the AAOS. This study revealed the influence of CTEV treatment had a more negative impact on females for quality of life and physical function.