Correlation of radiographic parameters with clinical correction in idiopathic congenital talipes equinovarus undergoing Ponseti treatment

Addosooki, Ahmad; Tammam, Hamdy; Morsy, Ahmed Fawaz; Marzouq, Ashraf; Ahmed, Emad H.; Ahmed, Ahmed M.; Said, Elsayed

doi:10.1007/s00264-021-05138-7

Cited by 5 publications

(4 citation statements)

References 38 publications

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“…However, a previous study showed a 33%-41% rate of recurrence[ 15 , 16 ]. Clubfoot is pathogenically characterized by abnormal bone alignment and abnormal radiographic features compared with normal feet, including bony abnormalities from incorrect treatment, whereas radiographic features from correct treatment are obviously better than pre-treatment[ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Can immediate postoperative radiographs predict outcomes in pediatric clubfoot?

Leeprakobboon¹

2022

World J Orthop

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BACKGROUND The goal of treatment for pediatric idiopathic clubfoot is to enable the patient to comfortably walk on his or her soles without pain. However, currently accepted treatment protocols are not always successful. Based on the abnormal bone alignment reported in this disease, some studies have noted a correlation between radiographic characteristics and outcome, but this correlation remains debated. AIM To assess the correlation between immediately postoperative radiographic parameters and functional outcomes and to identify which best predicts functional outcome. METHODS To predict the outcome and prevent early failure of the Ponseti’s method, we used a simple radiographic method to predict outcome. Our study included newborns with idiopathic clubfoot treated with Ponseti’s protocol from November 2018 to August 2022. After Achilles tenotomy and a long leg cast were applied, the surgeon obtained a single lateral radiograph. Radiographic parameters included the tibiocalcaneal angle (TiCal), talocalcaneal angle (TaCal), talofirst metatarsal angle (Ta1st) and tibiotalar angle (TiTa). During the follow-up period, the Dimeglio score and functional score were examined 1 year after surgery. Additionally, recurring events were reported. The correlation between functional score and radiographic characteristics was analyzed using sample and multiple logistic regression, and the optimal predictor was also identified. RESULTS In total, 54 feet received approximately 8 manipulations of casting and Achilles tenotomy at a mean age of 149 days. The average TiCal, TaCal, Ta1st, and TiTa angles were 75.24, 28.96, 7.61, and 107.31 degrees, respectively. After 12 mo of follow up, we found 66% excellent-to-good and 33.3% fair-to-poor functional outcomes. The Dimeglio score significantly worsened in the poor outcome group ( P value < 0.001). Tical and TaCal showed significant differences between each functional outcome ( P value < 0.05), and the TiCal strongly correlated with outcome, with a smaller angle indicating a better outcome, each 1 degree decrease improved the functional outcome by 10 percent. The diagnostic test revealed that a TiCal angle of 70 degrees predicts an inferior functional outcome. CONCLUSION The TiCal, derived from lateral radiographs immediately after Achilles tenotomy, can predict functional outcome at 1 year postoperatively, justifying its use for screening patients who need very close follow-up.

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Section: Discussionmentioning

confidence: 99%

Can immediate postoperative radiographs predict outcomes in pediatric clubfoot?

Leeprakobboon¹

2022

World J Orthop

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“…The axis of the talar neck was defined by a line passing through the midpoint of the talar head and talar neck. (5) The transverse talar neck angle was considered by drawing lines through the long axis of the talus body and talus head; (6) the transverse talonavicular angle was measured by drawing perpendicular lines to the navicular baseline and to the transmalleolar axis; and (7) the transverse talocalcaneal angle was measured by drawing lines through the long axis of the calcaneus and the talar body. These angles were measured by maintaining a superimposing image.…”

Section: Methodsmentioning

confidence: 99%

“…A number of x-ray, computed tomography (CT), and computerized three-dimensional reconstructions on CT, arthrography, infrared thermal imaging, and ultrasound (US) studies on clubfoot have been performed in recent years (5)(6)(7)(8)(9)(10)(11)(12)(13). Due to the tarsal bones of infants are not completely ossified and are primarily cartilaginous, it has been difficult to assess the morphology and alignment of tarsal bones using x-ray and CT. Arthrography has been recommended for better visualization of tarsal bones, such as cartilage, but this is an invasive procedure (11).…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging of Clubfoot Treated With the Ponseti Method: A Short-Term Outcome Study

Zhang

Wang

et al. 2022

Front. Pediatr.

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ObjectiveTo quantitatively evaluate the effectiveness of the Ponseti method for the correction of clubfoot, we decided to use magnetic resonance imaging (MRI) to evaluate changes in the tarsal bone relationship.MethodsThis is a retrospective study of fifteen children with clubfeet who were treated with the Ponseti method. MRI studies were obtained using a 3.0T Machine (GE Healthcare, United States). T1-weighted and T2-weighted images were acquired in the standard anatomic sagittal, transverse, and coronal planes. For the measurement, the best slice that clearly demonstrated the anatomy was chosen. Sagittal talocalcaneal angle, sagittal tibiocalcaneal angle, coronal tibiocalcaneal angle, transverse talar neck angle, transverse talonavicular angle, and transverse talocalcaneal angle were measured. The eighteen corrected clubfeet were compared with the twelve unilateral normal feet at clinical and radiological levels using a Pirani scoring system and MRI, respectively.ResultsIn total, 15 cases (twelve boys and three girls) with clubfeet were examined by using MRI. Twelve cases had unilateral and three had bilateral involvement (eleven left clubfeet and seven right clubfeet), giving a total of eighteen clubfeet when compared with twelve normal feet. The mean age of patients at examination was 47.7 months (8–96 months). The recovery of the corrected clubfoot in these patients met the goals of Ponseti treatment (functional, normal looking, pain-free, and plantigrade foot). Before Ponseti treatment, the mean Pirani score of clubfoot was 5.5 (5–6). During this follow-up, the Pirani score was 0.07 (0–0.05). The results of the MRI indicated that only the transverse talonavicular angle showed a significant difference between the treated clubfeet and the normal feet (p < 0.001). One case had dorsal talonavicular subluxation in the sagittal plane and had the lateral subluxation of the navicular in the transverse plane, which has never been reported in previous studies.ConclusionAlthough the appearance and function of clubfoot were recovered well after the Ponseti method, the results of MRI indicated that the Ponseti method successfully corrected the varus, cavus, and equinus deformities and incompletely corrected the adduction deformity regarding transverse talonavicular angle. At the same time, the Ponseti method may cause dorsal talonavicular subluxation in the sagittal plane and lateral subluxation of the navicular in the transverse plane on MRI.

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“…The frequency of post-traumatic ankle arthrodesis has increased in recent years due to sports practice; however, sports activity level [10] following an ankle fusion is decreased, and many patients will not return to their pre-injury level of activity. The clubfoot pathology rarely recurs in adulthood when corrected in childhood with the classical Ponseti technique [11,12] or with a new technology [13] with sensors integrated in the brace. However, a neglected clubfoot [14] or persistent deformities with arthritic pain may require further arthrodesis during adulthood.…”

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confidence: 99%