Yet Another Study That Tells Us What We Already Know

Well, perhaps it can be chalked up to poor funding for real long-term studies, or maybe it's merely a lack of imagination, but once again we have a study telling us what we already know using protocols that fail to ask the right questions of the right target population. In a recent study, (Adam Graf, MS, et al. Long-Term Outcome Evaluation in Young Adults Following Clubfoot Surgical Release. In Journal of Pediatric Orthopaedics. June 2010. Vol. 30, No. 4. Pp. 379-385.), the findings are not only not surprising, they are also less-than-stellar as regards the conclusions as stated in an article about this study, at eorthopod, to whit:

The pain and movement issues lowered the AODFAS scores in both the Ankle/Hindfoot and the Midfoot scales. The Disease Specific Index, another assessment, found that 96 percent of the feet were painful. (italics added) Results also showed that patient who were on their feet for long periods of time or needed to do stressful activities, such as running, jumping, or stair climbing, to name a few, experienced more problems with their affected foot or feet. In fact, all patients reported some level of pain at the end of the day or after strenuous exercise.

The conclusion seems to be that adults who were treated as children for their clubfoot or feet still have issues with their feet later in adulthood. (well, duh!) Although these problems don't cause problems with basic daily living, (Big Fail Here!) they do provide limitations in how active the patients can be. The authors suggest that following these patients into their later years to see if any changes occur, particularly as they enter the stages where arthritic changes may occur. (poor syntax was in the article, not my fault!)

They don't cause problems with basic daily living! Gotta love that one! Who were these investigators (being generous here) actually talking to? Well, you can see from the below items that they followed up on people as old as 24 years old!! Yeah, that's about as long-term as they seemed interested in. Too sarcastic? Maybe, but here we just have another half-hearted attempt to get something published rather than a real effort to get at the facts. To  make it worse, they study only covered a very small patient population:

The authors of this article reviewed and evaluated the long-term outcomes of the comprehensive surgical release. They collected data from 24 adults (17 males), aged from about 18 years old to 24 years old and a control group (with no clubfoot) of 48 people. Eleven patients had only one clubfoot (unilateral), while the remaining had two clubfeet (bilateral>). As children, none were successful with casting so they underwent surgery before they were 18 months old. Fourteen patients went on to have further repairs.(Again, a poor language choice - "repair" suggests a fix was found, whereas many of us know that so-called repairs are often as damaging as the initial interventions.)

 Now, I want to believe that the authors were sincere about getting at some elements of the truth, but perhaps we need to see some clubbies get into the field and be the people to conduct the serious studies we need to see done that may finally convince the medical establishment that more needs to be done. Until then, I hope you will forgive my sarcasm and skepticism about studies that fail to go as far as they need to. They consistently fail to seek out older clubbies to include in their studies, they fail to address the real issues we face daily, and while seeking answers as to etiology are certainly important, they neglect those of us who are already trapped with feet that encase our lives in the cement of chronic pain. They need to start asking better questions. And they need to start listening to us, if they ever hope to learn anything new.

 

I would suggest they start by making contact with the Facebook group over at adults/teens with club feet.  They would have a very receptive audience.