PhD Defence Arnold Timotheus Besselaar

Keywords: Clubfoot, Evolution of care, Quality of life, Relapse (treatment) 
 

"Walking with the clubfoot child Evolution of clubfoot care in the Netherlands"

This dissertation describes the changes in the treatment of clubfoot, a congenital foot defect in children, in the Netherlands.  After the introduction of the so-called Ponseti method (a then new plaster cast reduction technique to treat these feet), we have studied the course of this treatment over the past 15 years. Due to a strong demand (especially from parents!) for a guideline for care providers, we developed in the Netherlands and published it. The dissertation further describes the study in which the incidence was determined of the number of clubfoot patients in the Netherlands. Of course, we also wanted to know how these children were doing in time and to this end two quality of life studies were conducted in two different age groups: while wearing the brace (as part of the treatment) and a second one in the age group 5-9 years. Remarkable was the fact that the scores of these measurements were relatively high but showed individual differences so attention by the doctor remains important. Next, two studies on relapse of the clubfoot deformity were described: one in which the different forms, detection and timing of relapse were studied. Early detection was found to be essential and long follow-up as well. Treatment should be tailored to the individual. Growth influencing is a new treatment in which the effect in the foot was demonstrated but the gait effect in daily life should be further investigated by follow-up research. In summary, this dissertation describes a long-term research trajectory initiated by questions from clinical practice. Always with the goal of optimizing patient care of children with clubfoot deformities.

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