Radiographic Indicators of Surgery and Functional Outcome in Ponseti-Treated Clubfeet

Abstract

Level III, retrospective case series.

Early Radiographic Changes in the Lateral Talocalcaneal Angle Following Achilles Tenotomy in Children With Idiopathic Clubfoot

“…8 Radiographic measurements allow us to objectively evaluate the outcomes of foot disorders, including clubfoot. 6,8,18,19 According to Ponseti and other authors, it is difficult to reliably estimate the accurate position of tarsal bones in newborns and very young children because of the lack of ossification (immature ossification centers). 1,6 The strength of our study is that we consistently used the same technique to clinically assess the amount of dorsiflexion (pre-ADF max and post-ADF max ) and to measure the radiographic changes in the LTCA (pre-LTCA max , post-LTCA neutral , post-LTCA max ) on C-arm images taken with the foot in the same position (Figure 2 and Figure 3).…”

“…Moreover, the LCTA has been shown to be an important prognostic index, as a reduction in the LTCA is frequently associated with poor functional outcome. 18 It is therefore expected that improvements in the talocalcaneal angle in the sagittal plane would be associated with similar improvements in the transverse plane. Third, this study did not evaluate changes in the LTCA and ADF over time.…”

“…Moreover, the LTCA is an important prognostic index, as a reduction in the LTCA is frequently associated with poor functional outcome. 18 The aim of this study was to evaluate the immediate postoperative radiographic changes in the LTCA following PAT in children with idiopathic clubfoot treated according to the Ponseti method. The secondary aim was to measure the changes in maximal ankle dorsiflexion (ADF) following PAT and to evaluate whether any correlation exists between the radiographic and clinical changes.…”

Radiographic Prognostic Factors for Selective Soft Tissue Release After Ponseti Failure in Young Pediatric Clubfoot Patients

“…Some of these angles have been reported previously to predict the outcomes of idiopathic clubfeet that are treated with the Ponseti method. 30 To summarize the results more generally, the radiographic angles that have prognostic value are as follows: (1) the postoperative TM (AP), TC (lateral), and LTiC angles (note that these angles all changed significantly after SSTR) and (2) the preoperative TC (AP and lateral) angles. The fact that preoperative TC angles were not changed by SSTR and that these angles predicted recurrence suggest that SSTR may be limited in its ability to correct TC alignment, which is important for prognosis ( Figure 2).…”

What is new in idiopathic clubfoot?

“…The reliability of radiographic measures in infants with clubfoot deformity was recently demonstrated [32], and multiple studies have explored the utility of plain radiographs in predicting recurrent or treatment-resistant clubfoot. 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].…”