First trimester physiological development of the fetal foot position using three‐dimensional ultrasound in virtual reality

Abstract

Aim In anatomic studies of the embryo, it has been established that during the development of the lower limb, several changes in foot position can be observed defined as a temporary ‘physiological clubfoot’. The aim of this study was to develop and test a measurement tool for objective documentation of the first trimester foot position in vivo and made an attempt to create a chart for first trimester foot position. Methods We developed a virtual orthopedic protractor for measuring foot positioning using three‐dimensional virtual reality visualization. Three‐dimensional ultrasound volumes of 112 pregnancies of women examined during the first trimester were studied in a BARCO I‐Space. The frontal angle (plantar flexion) and the lateral angle (adduction) between the leg and foot were measured from 8 until 13 weeks gestational age. Results We observed that the frontal angle steadily decreases, whereas the lateral angle first increases, resulting in transient physiological clubfeet position at 10‐ to 11‐week gestation, followed by a decrease to a normal foot position. Conclusion A transient clubfoot position is present during the normal development of the lower limbs, and it has been measured in vivo for the first time. This study emphasizes that a diagnosis of congenital clubfoot should not be made in the first trimester of pregnancy.

Congenital talipes equinovarus (clubfoot)

“…2,7,9 Before 13 weeks of gestation, a transient clubfoot position can be present as part of normal development. 10 To diagnose clubfoot, one must visualize both the tibia and fibula in the same plane as the sole of the foot (Figures 1 and 2). Abnormal positioning persists over the duration of the scan.…”

Evaluation of embryonic posture using four‐dimensional ultrasound and virtual reality

“…Bogers et al . showed that measurements of the embryonic foot position were feasible using 3D ultrasound datasets which were studied using VR 9 …”

“…Bogers et al showed that measurements of the embryonic foot position were feasible using 3D ultrasound datasets which were studied using VR. 9 From this background we hypothesize that embryonic posture at rest during the early prenatal period, even in uneventful pregnancies, will demonstrate already small variations, as a proxy for neurobehavior/ neurodevelopment. We therefore aim to assess feasibility and reproducibility of embryonic posture evaluation at rest at 9 (+0-6 days) weeks' GA using 4D ultrasound and VR techniques.…”

High Frequency of Fetal Loss in Fetuses with Normal Karyotype and Nuchal Translucency ≥ 3 among the Iranian Pregnant Women

“…Around 11th to 14th weeks of pregnancy Nuchal translucency (NT) is measured by sonography in fetus ( 10 ). The size of NT shows the amount of fluid behind the neck of the fetus.…”

“…The amount of fluid behind neck can be increased in fetus with normal karyotype. In this condition fetus is at a significant risk of still birth, heart defect, and delay in neurodevelopment ( 10 - 12 ).…”