Radiographic Abnormalities of the Talus in Patients With Clubfoot After Surgical Release Using the McKay Technique

Abstract

Objective: To analyze morphological abnormalities of the talus in patients with clubfoot after surgical treatment using the McKay technique. Method: Lateral standing-position radiographs of the feet of 14 patients with unilateral clubfoot who underwent treatment by means of the doubleincision McKay technique were retrospectively analyzed. All the patients were operated by the same surgeon, with an average of 6.53 years between surgery and the radiograph. We compared the radiographic characteristics of the talus between the operated and the contralateral foot. We assessed the presence of deformity of the talar dome and head (sphericity evaluation); the talar length and height; the percentage and degree of navicular subluxation; abnormalities of the Gissane angle; and the trabecular bone pattern. Results: Abnormalities of the talar head occurred in 92.8% of the patients; of the talar dome in 92.8%; and of the trabecular pattern in 100%. The talar length ratio between the operated and the contralateral foot ranged from 0.61 to 0.88 (mean 0.79; SD = 0.09), while the height ratio ranged from 0.57 to 0.98 (mean 0.82; SD = 0.12). The Gissane angle was greater in all of the operated feet, and all of them also showed navicular subluxation, at a rate ranging from 6.43 to 59.75% (mean 26.34%; SD = 16.66%). Conclusion: Talar abnormalities occurred in 100% of the feet treated using the McKay technique. It was shown that establishing radiographic parameters to describe and quantify these deformities was feasible, through simple and easy-to-perform techniques.

Radiological tarsal bone morphology in adolescent age of congenital clubfeet treated with the Ponseti method

“…Eight parameters characterizing the shape of the tarsal bones were measured/calculated as previously described (Fig. 2a-e) [13,14,20]: Talar length (TL), the radius of the trochlea tali (RT) and the talar height (TH) were measured in the lateral view of the foot and the ratio radius/length (RT/LT) was calculated accordingly. To describe the angular segment available for tibiotalar dorsiflexion the "anterior talar motion segment" (ATM) was measured in the lateral view.…”

“…Radiographic and sonographic studies on the development of tarsal bone shape in treated clubfeet revealed marked differences from normal feet but observed also some methodological difficulty in detecting morphological differences with these imaging modalities [ 6 – 10 ]. Additionally, it is unknown whether severe tarsal bone deformities, often observed after primary surgical therapy of clubfeet, occur or persist after the Ponseti treatment [ 11 – 14 ]. Clinical experience with residual clubfoot deformities in adult patients shows that in many cases the condition of the ankle will determine the long-term clinical outcome [ 15 – 17 ].…”

“…Clinical experience with residual clubfoot deformities in adult patients shows that in many cases the condition of the ankle will determine the long-term clinical outcome [ 15 – 17 ]. In this context, supramalleolar valgus misgrowth and dysplasia of the talus with a significantly reduced or flattened articular surface of the trochlea tali (“flat top talus”) have often been observed after initial surgical treatment of clubfeet and were associated with poor clinical outcome [ 12 , 14 , 18 ]. Comparable deformities might also affect the outcome after therapy with the Ponseti method.…”

“…Additionally, it is unknown whether severe tarsal bone deformities, often observed after primary surgical therapy of clubfeet, occur or persist after the Ponseti treatment [11][12][13][14]. Clinical experience with residual clubfoot deformities in adult patients shows that in many cases the condition of the ankle will determine the long-term clinical outcome [15][16][17].…”

Achilles Lengthening

“…Figure 1. Talar sphericity patterns: (A) normal, enabling good mobility of the joint, (B) slightly flattened, (C) greatly altered or flat 7. …”