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

Abstract

Background Major abnormalities of tarsal bone shape after surgical clubfoot treatment are well known from the literature. The Ponseti method has gained widespread acceptance in primary treatment of congenital clubfeet. Despite the longtime experience, data regarding the development of tarsal bones after this treatment are still rare. The aim of the study was therefore to evaluate radiographic parameters describing tarsal bone shape of clubfeet after Ponseti treatment and compare them to age-matched healthy feet. Methods Twenty two consecutive severe clubfeet in 14 patients were investigated by repeated diagnostic ultrasound during the corrective process. Extent and temporal course of correction were documented with standardized X-rays after a mean follow-up of 12 years (between the ages of 10–14 years) and compared to a group of age-matched normal feet. Results Reliability testing for all X-ray parameters showed good to excellent results. In comparison to the control group, all parameters except the radius of the trochlea (RT) were significantly altered in clubfeet with highest differences shown for the anterior talar motion segment (ATM), talonavicular coverage (TNC) and the talometatarsal index (TMT-Index). Differentiation between minor and major deformities showed significant differences only for the front tarsal index (FTI). Conclusions Tarsal bone shape of clubfeet treated by the Ponseti method differs significantly from normal feet. One of the most pronounced and clinically relevant difference of the clubfoot talus compared to the normal talus is the markedly reduced anterior talar motion segment.

Flat-top talus after clubfoot treatment: a literature review

“…Two studies describe in detail the radiological morphology of the talus in treated clubfeet. Hamel et al [17] found the most consistent difference compared to controls was the previously described loss of dorsal talar neck depth, which they refer to as the 'anterior motion segment'. An MRI study by Feng et al [18] corroborates this, showing that the depth of the 'talar groove' was on average 2 mm less in clubfeet than in controls.…”

“…Hamel et al . [17] found the most consistent difference compared to controls was the previously described loss of dorsal talar neck depth, which they refer to as the ‘anterior motion segment’. An MRI study by Feng et al .…”

“…It might, however, suggest that feet with worse talar morphology prior to treatment are harder to treat, and, therefore, need more casts. Indeed, Hamel et al [17] found that talar morphology after Ponseti treatment was related to original severity of the clubfoot deformity.…”

“…Indeed, Hamel et al . [17] found that talar morphology after Ponseti treatment was related to original severity of the clubfoot deformity.…”

Clinical meaningfulness of the Oxford Foot Model to assess foot deformity during gait

“…The FPS validation paper has been further cited in outcome-based studies (26,33) and in a systematic review of assessing foot-types (34). The study analysing foot function and perceived outcomes in symptomatic clubfoot has been cited in review papers of clubfoot management (35,36) and outcome-based studies (26,37).…”