Can Radiographs Predict Outcome in Patients With Idiopathic Clubfeet Treated With the Ponseti Method?

O’Halloran, Conor P.; Halanski, Matthew A.; Nemeth, Blaise A.; Zimmermann, Catherine C.; Noonan, Kenneth J.

doi:10.1097/bpo.0000000000000354

Cited by 19 publications

(13 citation statements)

References 6 publications

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“…Radiographic measurements on the anteroposterior view of the foot included hallux interphalangeal angle, 16 hallux valgus angle, 17 distal metatarsal articular angle, 18 first and second intermetatarsal angle, 17 first and second intermetatarsal relative length 19 , 20 and metatarsus adductus angle (MAA). 21 Radiographic measurements on the lateral view of the foot included talo-first metatarsal angle, 22 talo-horizontal angle, 23 talocalcaneal axial angle, 24 talocalcaneal pitch angle 25 and calcaneal pitch. 22 , 26 Radiographic measurements on the anteroposterior view of the ankle included tibiotalar angle (TTA) 10 and medial distal tibial angle (MDTA).…”

Section: Methodsmentioning

confidence: 99%

Foot and ankle deformities in children with down syndrome

Perotti

Abousamra

Orozco

et al. 2018

Journal of Children's Orthopaedics

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PurposeFoot and ankle deformities are common orthopaedic disorders in children with Down syndrome. However, radiographic measurements of the foot and ankle have not been previously reported. The aim of this study is to describe the foot and ankle deformity in children with Down syndrome.MethodsChildren who had foot and ankle radiographs in the standing weight-bearing position were selected. Three groups of patients were identified. The relationship of radiographic measurements with age, body mass index and pain is discussed. In all, 41 children (79 feet) had foot radiographs and 60 children (117 ankles) had ankle radiographs, with 15 children overlapping between Groups I and II.ResultsIn Group I, hallux valgus deformity was seen before ten years of age and hallux valgus angle increased afterwards. Metatarsus adductus angle showed a significant increase (p = 0.006) with obesity and was higher in patients who had foot pain (p = 0.05). In Group II, none of the ankle measurements showed a significant difference with age or body mass index percentiles. Tibiotalar angle (TTA) and medial distal tibial angle (MDTA) were higher in patients who had ankle pain. In Group III, correlation analysis was performed between the different measurements with the strongest correlations found between TTA and MDTA.ConclusionIn children with Down syndrome, radiographic evaluation of the foot and ankle reveals higher prevalence of deformities than clinical examination. However, foot and ankle radiographs are needed only for symptomatic children with pain and gait changes.Level of EvidenceLevel IV - Prognostic Study

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Section: Methodsmentioning

confidence: 99%

Foot and ankle deformities in children with down syndrome

Perotti

Abousamra

Orozco

et al. 2018

Journal of Children's Orthopaedics

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“…4,6,7,18 Several studies have shown that residual equinus deformity (the extent of ankle dorsi exion) before and after Achilles tenotomy are related to a higher need for future operative intervention. 9,10,12 Kang et al indicated that lateral TCA measured by radiographs is more objective than physical examination only and is also a predictor for the necessity of performing PAT. 10 All our TCAs measured by radiographs after PAT were over 10 degrees and did not receive further intervention.…”

Section: Discussionmentioning

confidence: 99%

Lengthening of Achilles Tendon from the Percutaneous Tenotomy Procedure in Ponseti’s Method

Lin¹,

Chang²,

Lai³

2020

Preprint

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Background Talipes equinovarus is one of the common congenital disease of foot deformity of newborn. Initial treatment is often with the Ponseti method. Studies have demonstrated that radiographic measurements can be made with clubfoot. The purposes of this study were to document the amount of Achilles tendon lengthening obtained from PAT in Ponseti’s method and to analyze the factors that might impact on the amount of equinus correction. Methods This is a retrospective study carried out from 2002 to 2006. Sixteen feet of twelve children that received percutaneous Achilles tendon tenotomy (PAT) for the treatment of congenital clubfoot were included. Assessments before and after treatment were performed using Dimeglio system. The foot length from toe to heel at the time of PAT, the pre- and post-PAT ankle dorsiflexion and post-casting lateral view of foot were obtained. The Pearson correlation coefficient was used to establish relationships between pre-, post-PATT and post-casting Tibio-calcaneal angle (TCA) and Achilles tendon length(ATL).Results The TCA before, after PATT, and after casting were -9.3, 27.4 and 18.4degrees. The ATL before, after PATT, and after casting were 22.7, 31.3, and 28.3mm. The overall lengthening of Achilles tendon was 5.7% of the foot length. The pre-PATT TCA was correlated with post-PATT and post-casting TCA. The pre-PATT ATL was correlated with post-PATT ATL and post-casting ATL.Conclusion Post-PAT correction effect is negatively correlated with the pre-PAT severity of equinus. The comparison between post-PAT and post-casting TCA could be used to check the quality of casting in the Ponseti method.Level of Evidence: level IV

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“…Shabtai et al claim that on the lateral view with the foot in maximal dorsiflexion, a tibiocalcaneal angle greater than 77°and a talocalcaneal angle less than 29°are helpful in predicting functional outcome and need for additional surgery [33]. In a separate study, dorsiflexion less than 16°on lateral forced dorsiflexion pre-tenotomy radiograph was associated with an increased risk of recurrence in Ponseti-treated clubfeet [34].…”

Section: Predicting Treatment Resistance and The Role Of Imagingmentioning

confidence: 99%