Ultrasound evaluation of foot deformities in infants

Abstract

Foot deformity in infants is the most common congenital musculoskeletal condition. A precise diagnosis can sometimes be impossible to establish clinically. Radiologic imaging plays a major role in the evaluation of musculoskeletal abnormalities. However conventional imaging techniques, such as plain radiographs of the foot, are of very little help in this age group because of the lack of ossification of the tarsal bones. US presents a significant advantage because it permits the visualization of cartilaginous structures. This leads to the detailed assessment of foot deformities in infants. Furthermore, US can also be used as a dynamic imaging modality. Different scanning views are beneficial to evaluate the complete anatomy of the foot; depending on the suspected clinical diagnosis, some planes are more informative to display the pathological features of a specific deformity. We describe the US findings of five of the most common foot deformities referred to our pediatric orthopedic clinic (clubfoot, simple metatarsus adductus, skewfoot, and oblique and vertical talus). For each deformity we propose a specific imaging protocol based on US to provide an accurate diagnosis. US is a complementary tool to the clinical examination for determining the diagnosis and the severity of the deformity and also for monitoring the efficacy of treatment. Radiologists investigating foot deformities in infants should consider using US for the detailed assessment of the foot in this age group.

The identification and appraisal of assessment tools used to evaluate metatarsus adductus: a systematic review of their measurement properties

“…First cuneiform metatarsal angle (medial angulation of first cuneometatarsal joint) 3. Metatarsal-metaphyseal angle (metatarsal metaphyseal incurvation) Rigid Metatarsus adductus scheduled for surgery Not stated Weight bearing radiographs No Miron [ 21 ] Expert Opinion Canada N/A Not stated Not stated Lateral displacement of the medial (first) cuneiform over the navicular as the single feature. Not applicable Not applicable Ultrasonography Yes Lepow [ 25 ] Retrospective cohort USA 15 7/8 6 months, (2–15 months) 1.…”

“…Radiographs and the associated angles measure the osseous deviation and change. In the younger population, the lack of tarsal bone ossification does not allow many of these angles to be easily calculated [ 21 ]. The radiographic angles with the highest reliability [ 32 , 33 ] identified in this review were calculated and reliant on osseous structures that appear after the age of five [ 38 ].…”

“…Ultrasonography was utilised as a dynamic imaging modality for quantification of metatarsus adductus in infants as it allows for the imaging of the cartilaginous structures. It also differentiates between metatarsus adductus and skewfoot, as in metatarsus adductus the medial cuneiform will be displaced laterally over the navicular [ 21 ]. Whilst this is a new imaging modality, no studies have assessed the measurement properties of this method.…”

“…Photocopying the child’s foot poses potential risk due to glass breakage. Recent studies suggest the use of ultrasound as a measurement technique as it allows for the imaging of cartilaginous structures [ 21 ].…”

Range of motion in the talo-navicular and the calcaneo-cuboid joints evaluated by ultrasound during clubfoot treatment with normal references up to the age of four years

“…Ultrasound is a radiation-free, reliable imaging modality suitable for evaluation of congenital foot deformities. 4 – 7 Ultrasound evaluation has been demonstrated to show better correlation to the severity grading of clubfeet than radiographic measurements. 8 Ultrasound protocols and normal values for the first year of life have been published.…”