Abstract
Congenital Talipes Equinovarus (CTEV) or clubfoot is the commonest congenital orthopaedic condition with an incidence of 1. 5 per 1000 in the UK. The usual treatment for CTEV is the Ponseti method, consisting of serial manipulation and casting followed by immobilisation in a foot brace. Two main factors have an effect on treatment result: deformity relapse due to muscle imbalance, creating the need for surgery, and smaller ankle range of motion (ROM) and calf circumference (CC). This study investigated the practicality of surface neuromuscular electrical stimulation (NMES) as an ‘active’ intervention in infants with CTEV. The primary outcome measure was the potential to reduce relapse measured by the Pirani score and secondary outcome measures were increase ROM and calf circumference. An A1BA2 approach (A-stimulation, B-non-stimulation), six weeks each phase, was used in a study and a control group each with eight feet. At each session evertor muscle activity, Pirani severity score and static measures were assessed. Usage and parent perception was assessed using a questionnaire. The compliance with the stimulation and the brace were monitored by diary cards. A separate study with normally developing feet (n=26) and clubfeet (n=14) was also undertaken to determine the repeatability of the static measures. The repeatability study provided acceptable limits for ankle dorsiflexion knee flexed (ADKF), ankle dorsiflexion knee extended (ADKE) and CC. The results from the stimulation study demonstrated a positive subjective perspective regarding the experience with stimulation. Statistical analysis demonstrated a significant improvement over the study period in ADKF and ADKE in the study group only. The changes were associated with the stimulation phases. Analysing the differences between consecutive measurements demonstrated a significantly different change only in ADKE during the second stimulation phase. In the rest of the outcome measures no significant difference was found between the study and the control group. The results from this study have been encouraging, with two particular cases appearing to be very appropriate for NMES treatment; the non compliant feet and the feet with poor evertor activity. However, further work, e. g. an extended, longitudinal study, is required to determine the role of NMES in the treatment of CTEV.