Evaluation of rotational profile and foot loading in the uninvolved leg of children with unilateral clubfoot treated with foot abduction orthoses.

Ponseti treatment of congenital clubfoot utilizes foot abduction bracing to prevent recurrence. In unilateral clubfoot, families have expressed concern about inducing deformity in the uninvolved leg. This study evaluated rotational profiles of uninvolved legs in children with unilateral clubfoot. We retrospectively reviewed 78 children (mean age: 9.5 ± 3.4 years) with unilateral idiopathic clubfoot treated by Ponseti method at a single institution from 2008 to 2025. Motion capture kinematics evaluated hip, tibial, ankle rotation, and foot progression angle (FPA). Physical exam evaluated bimalleolar axis, hip rotation, and thigh-foot angle (TFA). Pedobarographic data evaluated FPA and foot loading. Results compared to normative cohorts of typically developing children using unpaired t-tests (P < 0.05). The uninvolved side demonstrated more kinematic internal ankle rotation (3.9 ± 7.3 vs. 0.9 ± 5.6°; P = 0.0004), more kinematic external hip rotation (-4.4 ± 9.6 vs. 1.2 ± 6.8°; P = 0.0001), less hip internal rotation on exam (47.4 ± 13.2 vs. 57.6 ± 12.3°; P = 0.0001) and more external bimalleolar axis (-19.0 ± 6.8 vs. -16.0 ± 5.9°; P = 0.0091). There was no difference in TFA or FPA. Pedobarographic analysis showed no foot loading or FPA impact. The uninvolved limb in unilateral clubfoot develops statistically significant external hip rotation and increased external bimalleolar axis compared to normative controls, though kinematic tibial internal rotation was not significantly different. However, there was no significant impact on TFA, FPA, or foot loading, indicating that these differences are clinically insignificant. Awareness of these changes is helpful for counseling and reassuring families. This is a level III retrospective case-control study.