DISCUSSION
The group of babies diagnosed with clubfoot in our study did present with a mild delay in the attainment of gross motor skills when compared with a group of babies who were typically developing. This delay did not become apparent until the babies were 9 months of age when they begin activities that required them to be in a more upright position with less surface support. During treatment of clubfoot, the most extensive physical constraints to typical development of gross motor skills such as full-time use of splints and braces occur in the first 3 months but delay in attainment of gross motor skill is not apparent until later. There are many possible reasons for the mild delay that are not clear from our data. The delay may be related to the constraints on motor movements caused by the restriction inherent in any clubfoot treatment method such as the use of braces or splints. There may be changes in the development of the baby’s foot position and function in the upright position that affect balance and equilibrium or strength of the baby’s foot and ankle muscle groups. It is also possible that the presence of clubfoot disorder may be a marker for underlying mild motor development dysfunction or that there are other inherent factors associated with clubfoot deformity that negatively affect gross motor proficiency. There may be a link between 1 or more of the multifactorial components of clubfoot etiology identified in the literature with consequences that negatively affect the development of gross motor skills. These components include genetic mutations and a variety of histopathologies related to retractive fibrotic responses and neuromyogenic imbalances.