Ballistic Movements in Children with Ponseti Correction
Renee Burnham, SPT, Boni Slagerman, SPT, and Mark Wilcox, SPT
22 Comments on “Ballistic Movements in Children with Ponseti Correction”
Since you just took measurements from one lower extremity, how did you determine which limb to take measurements from for the control group and for those who had clubfoot affecting bilateral LE’s? Thanks!
For the control group and the individuals with bilateral clubfoot, we used their dominant limb for measurement. We found this by having them kick a soccer ball. This was a limitation since there were unilateral clubfoot individuals who were affected on their non-dominant side and age and gender matched to control subjects who measurements were taken from their dominant limb.
Good question, Ms. Tobin. We instructed the child to kick a ball to determine which foot was their dominant foot. Then, we measured that foot. For example, if a control subject or bilaterally-affected subject kicked the ball with their right foot, we used the right foot in our measurements. Thanks!
After knowing what you know now about your study, if you were to repeat this study is there anything that you would choose to do differently. If yes, why?
I think we should have informed the parents not to have their child go to an activity that requires a lot of energy before testing. We had one child that was in the control group that had two birthday parties before we tested him and unfortunately he was tired and had a hard time completing the tests to his best abilities. This made him an outlier in our control group that could have skewed the results of our data.
I see that you only had 2 children who were affected unilaterally, but I was wondering if you saw any difference with those children compared to those affected bilaterally? Also, if the child’s unilateral involvement was not his/her dominant foot, did you have to compensate for this?
We did not compare measurements and testing results for those two unilateral children compared to the bilaterally affected children. This would be interesting to go back to the data and see if there are differences between these two groups. We did not compensate for unilateral involvement of the non-dominant foot. One way we could have compensated was taken the non-dominant measurement of the age and gender matched control subject.
You mention in your Future Research section that research involving agility and balance of this population is underway. Based on the results of your study and what you have learned about this topic, what do you anticipate the results of those to be?
As the sample size increases with more participants, I think there will be a larger difference between the CTEV children and typically developing children. I would anticipate that CTEV children have lower balance and agility scores than typically developing children. However, I’m not sure the difference will be enough to be considered statistically significant.
In your clinical rotation experience thus far, have you seen any aspects of this research study applied? (e.g. similar testing performed in children, ballistic deficits in populations other than CVET, etc.)
I have not seen any of this information applied thus far in my clinical experience. In my current rotation in the school pediatric setting, I’ve noticed some differences in those who toe walk and have spina bifida, but I believe that is to be expected with certain diagnoses. I have not seen any of these tests being performed on children with or without a foot/ankle pathology.
I have used some of the objective tests and measures during my clinical rotation. In clinic, I have used the star excursion balance test for an assessment and for an intervention to work on narrow base of support balance with multidirectional dynamic movement. I have also gotten objective measures of dorsiflexion and plantarflexion (what we did in the study as well) and did quick passive motion assessments of pronation and supination. Gait assessment is another measure I have done in clinic that we sort of did in our study (we didn’t assess gait in our study until after we gathered our data, but we still assessed it). None of these measures listed above were taken form children in my clinical rotation, although I did use them.
So in your discussion you mention that the reasons why the standing broad jump might have produced significant differences between groups. I was wondering if you had any reasoning or ideas as to why the other ballistic performance measures did not show significant differences between the two groups.
Our group hypothesized that we did not see a significant differences in other ballistic measures as the sample size was small. Also, even though all the ballistic measures are assessing power and the efficiency of the stretch-reflex, specifically of the lower extremity and ankle, there are still differences in the demands of lower extremity with each of the ballistic tests.
Do you think you would have found statistically significant results had you used the non-dominant foot for testing in children with bilaterally involved limbs?
Good question, Jerrica. If we tested both the non-dominant and dominant lower extremities, we would have more data and potentially be able to see trends or patterns between dominant and non-dominant lower extremities. I’m unsure if the results would yield statistically significant results or not, as both limbs had undergone the same correction procedures.
Knowing what you discovered in your study, if you were to do it again would you test knee and/or hip mechanics to determine if these are affected in children with CTEV and what do you think you would discover?
Yes, if we had the time it would have been very interesting to take measures of the knee and hip and see if there is differences between groups. Even though the Ponseti approach works to correct the ankle and forefoot, there may be differences or compensations made in the more proximal chain that could be found to be significant. Great question and something that could be looked at in the future.
I think I would check both the knee and the hip if we did it again. If a joint is affected you should always check above and below that joint. So if the ankle is affected, I would like to see the knee and if the knee is affected I would like to check the hip as well. I think there could possibly be differences in strength and ROM, but then again if it was corrected early enough there could be no differences.
Hello,
I read above in the reply to the question as to whether or not you projected to see a difference when testing compares agility and balance, and the response indicated that a larger sample size would be hypothesized to show a greater between groups difference. Do you believe that a larger sample size would also so greater differences in the ballistic movements? or do you think your tests and measures are sensitive to record a between group difference? or is it of the researchers opinion that there truly are no differences in ballistic movement between groups?
We speculate that larger sample sizes will show greater differences in ballistic movements between the two groups, however these may or may not be significant differences.
USD PT Research 
Since you just took measurements from one lower extremity, how did you determine which limb to take measurements from for the control group and for those who had clubfoot affecting bilateral LE’s? Thanks!
LikeLiked by 1 person
For the control group and the individuals with bilateral clubfoot, we used their dominant limb for measurement. We found this by having them kick a soccer ball. This was a limitation since there were unilateral clubfoot individuals who were affected on their non-dominant side and age and gender matched to control subjects who measurements were taken from their dominant limb.
LikeLiked by 1 person
Good question, Ms. Tobin. We instructed the child to kick a ball to determine which foot was their dominant foot. Then, we measured that foot. For example, if a control subject or bilaterally-affected subject kicked the ball with their right foot, we used the right foot in our measurements. Thanks!
LikeLiked by 1 person
After knowing what you know now about your study, if you were to repeat this study is there anything that you would choose to do differently. If yes, why?
LikeLiked by 1 person
I think we should have informed the parents not to have their child go to an activity that requires a lot of energy before testing. We had one child that was in the control group that had two birthday parties before we tested him and unfortunately he was tired and had a hard time completing the tests to his best abilities. This made him an outlier in our control group that could have skewed the results of our data.
LikeLiked by 1 person
I see that you only had 2 children who were affected unilaterally, but I was wondering if you saw any difference with those children compared to those affected bilaterally? Also, if the child’s unilateral involvement was not his/her dominant foot, did you have to compensate for this?
LikeLiked by 1 person
We did not compare measurements and testing results for those two unilateral children compared to the bilaterally affected children. This would be interesting to go back to the data and see if there are differences between these two groups. We did not compensate for unilateral involvement of the non-dominant foot. One way we could have compensated was taken the non-dominant measurement of the age and gender matched control subject.
LikeLiked by 1 person
You mention in your Future Research section that research involving agility and balance of this population is underway. Based on the results of your study and what you have learned about this topic, what do you anticipate the results of those to be?
LikeLiked by 1 person
As the sample size increases with more participants, I think there will be a larger difference between the CTEV children and typically developing children. I would anticipate that CTEV children have lower balance and agility scores than typically developing children. However, I’m not sure the difference will be enough to be considered statistically significant.
LikeLiked by 1 person
In your clinical rotation experience thus far, have you seen any aspects of this research study applied? (e.g. similar testing performed in children, ballistic deficits in populations other than CVET, etc.)
LikeLiked by 1 person
I have not seen any of this information applied thus far in my clinical experience. In my current rotation in the school pediatric setting, I’ve noticed some differences in those who toe walk and have spina bifida, but I believe that is to be expected with certain diagnoses. I have not seen any of these tests being performed on children with or without a foot/ankle pathology.
LikeLiked by 1 person
I have used some of the objective tests and measures during my clinical rotation. In clinic, I have used the star excursion balance test for an assessment and for an intervention to work on narrow base of support balance with multidirectional dynamic movement. I have also gotten objective measures of dorsiflexion and plantarflexion (what we did in the study as well) and did quick passive motion assessments of pronation and supination. Gait assessment is another measure I have done in clinic that we sort of did in our study (we didn’t assess gait in our study until after we gathered our data, but we still assessed it). None of these measures listed above were taken form children in my clinical rotation, although I did use them.
LikeLiked by 1 person
Thank you for the clarification!
LikeLiked by 1 person
So in your discussion you mention that the reasons why the standing broad jump might have produced significant differences between groups. I was wondering if you had any reasoning or ideas as to why the other ballistic performance measures did not show significant differences between the two groups.
LikeLiked by 1 person
Our group hypothesized that we did not see a significant differences in other ballistic measures as the sample size was small. Also, even though all the ballistic measures are assessing power and the efficiency of the stretch-reflex, specifically of the lower extremity and ankle, there are still differences in the demands of lower extremity with each of the ballistic tests.
LikeLiked by 1 person
Do you think you would have found statistically significant results had you used the non-dominant foot for testing in children with bilaterally involved limbs?
LikeLiked by 1 person
Good question, Jerrica. If we tested both the non-dominant and dominant lower extremities, we would have more data and potentially be able to see trends or patterns between dominant and non-dominant lower extremities. I’m unsure if the results would yield statistically significant results or not, as both limbs had undergone the same correction procedures.
LikeLiked by 1 person
Knowing what you discovered in your study, if you were to do it again would you test knee and/or hip mechanics to determine if these are affected in children with CTEV and what do you think you would discover?
LikeLiked by 1 person
Yes, if we had the time it would have been very interesting to take measures of the knee and hip and see if there is differences between groups. Even though the Ponseti approach works to correct the ankle and forefoot, there may be differences or compensations made in the more proximal chain that could be found to be significant. Great question and something that could be looked at in the future.
LikeLiked by 1 person
Jerrica,
I think I would check both the knee and the hip if we did it again. If a joint is affected you should always check above and below that joint. So if the ankle is affected, I would like to see the knee and if the knee is affected I would like to check the hip as well. I think there could possibly be differences in strength and ROM, but then again if it was corrected early enough there could be no differences.
LikeLiked by 1 person
Hello,
I read above in the reply to the question as to whether or not you projected to see a difference when testing compares agility and balance, and the response indicated that a larger sample size would be hypothesized to show a greater between groups difference. Do you believe that a larger sample size would also so greater differences in the ballistic movements? or do you think your tests and measures are sensitive to record a between group difference? or is it of the researchers opinion that there truly are no differences in ballistic movement between groups?
Thank you
Jon Gray SPT
LikeLiked by 1 person
We speculate that larger sample sizes will show greater differences in ballistic movements between the two groups, however these may or may not be significant differences.
LikeLiked by 1 person