Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation




Kinesiology and Health Promotion

First Advisor

Dr. Robert Shapiro


Reoccurrence of deformity can affect upwards of 64% of children with clubfoot. The ability to use foot function as a measure of reoccurrence has not been previously assessed. The purpose of this investigation was to utilize foot pressure analysis to predict the probability of reoccurrence in children with unilateral clubfoot. Retrospective foot pressure data revealed predictive algorithms detecting the probability of experiencing any type of reoccurrence (overall reoccurrence) and for experiencing a tibialis anterior tendon transfer (TATT). The equation for overall reoccurrence reported sensitivity and specificity of 0.82 and 0.81 and the equation for TATT reported values of 0.81 and 0.84.

These algorithms were then applied prospectively to a cohort of children with unilateral clubfoot. Interim sensitivity and specificity results at a 1.5-year follow-up demonstrate that the equations for overall reoccurrence and TATT were highly specific but not sensitive (0.84, 0.73 specificity; 0.11, 0 sensitivity). This is an indication that these algorithms were more accurate when identifying the absence of reoccurrence. However, these results may change as the prospective subjects continue to age.

Overall, the results of this investigation show that foot pressure analysis can predict the presence/absence of reoccurrence. The algorithms developed herein have the potential to improve long and short-term outcomes for children with clubfoot. Providing clinicians with the probability of reoccurrence will improve their ability to be proactive during the treatment decision making process.

Digital Object Identifier (DOI)