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27.07.2021 | Original Paper

Correlation of radiographic parameters with clinical correction in idiopathic congenital talipes equinovarus undergoing Ponseti treatment

verfasst von: Ahmad Addosooki, Hamdy Tammam, Ahmed Fawaz Morsy, Ashraf Marzouq, Emad H. Ahmed, Ahmed M. Ahmed, Elsayed Said

Erschienen in: International Orthopaedics | Ausgabe 12/2021

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Abstract

Purpose

Idiopathic congenital talipes equinovarus is the most commonly encountered congenital deformity of the foot. Ponseti technique of manipulation is the treatment of choice. The Pirani classification is a reliable scoring system for clinical evaluation of clubfeet. The role of radiographic parameters in the evaluation and treatment of clubfeet is still controversial. The aim of this study was to evaluate the correlation of radiological parameters with clinical correction in patients with idiopathic clubfeet undergoing correction using Ponseti method.

Methods

Between March 2018 and March 2019, 42 feet in 27 patients with idiopathic clubfeet were treated in our hospital. We used the Pirani scoring system for clinical evaluation. Anteroposterior and lateral views of the feet were taken before and after correction and at the last follow-up. The anteroposterior view was evaluated for the talocalcaneal angle and talo-first metatarsal angle, while the lateral view was only evaluated for the talocalcaneal angle.

Results

Twelve were boys (44.4%), and 15 were girls (55.6%). The deformity was bilateral in 15 patients (55.6%) and unilateral in 12 patients (44.4%). The average age was three months. According to the Pirani score, the mean Pirani Total score was 4.4 before correction and reduced to 0.4 after correction. The mean talocalcaneal angle in anteroposterior and lateral views was 15.1° and 7.8° before correction, increased to 32.7° and 31.8° after correction, respectively. The mean talocalcaneal index increased from 23.2 before correction to 64.5 after correction. The mean talo-first metatarsal angle in anteroposterior view improved from 25.7° before correction to − 1.6° after correction. The relation between the differences in Pirani scores before and after correction and the differences in measured radiographic parameters before and after correction revealed a statistically significant correlation.

Conclusion

Radiographic parameters showed a statistically significant correlation with the clinical outcome. Thus, evaluation of clubfeet correction treated by Ponseti technique can rely mainly on clinical scores with limited utilization of radiological assessment.

Dobbs MB, Morcuende JA, Gurnett CA, Ponseti IV (2000) Treatment of idiopathic clubfoot: an historical review. Iowa Orthop J 20:59–64PubMedPubMedCentral

Palma M, Cook T, Segura J, Pecho A, Morcuende JA (2013) Descriptive epidemiology of clubfoot in Peru: a clinic-based study. Iowa Orthop J 33:167–171PubMedPubMedCentral

Morcuende JA (2006) Congenital idiopathic clubfoot: prevention of late deformity and disability by conservative treatment with the Ponseti technique. Pediatr Ann 35(2):128–30 (132-6)PubMedCrossRef

Saltzman HM (2009) Foot focus: international initiative to eradicate clubfeet using the Ponseti Method. Foot Ankle Int 30(5):468–471PubMedCrossRef

Steinman S, Richards BS, Faulks S, Kaipus K (2009) A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method. Surgical technique. J Bone Joint Surg Am 91(Suppl 2):299–312PubMedCrossRef

Carroll NC (2012) Clubfoot in the twentieth century: where we were and where we may be going in the twenty-first century. J Pediatr Orthop B 21(1):1–6PubMedCrossRef

Pirani S, Outerbridge H, Sawatzky B, Stothers K (1999) A reliable method of clinically evaluating a virgin clubfoot evaluation. 21st SICOT Congress, Sydney, Australia

B R (1896) On various forms of talipes as depicted by x-rays. Lancet 148(3803):160–162CrossRef

Ponseti I (1996) Congenital clubfoot: fundamentals of treatment. Oxford University Press, Oxford

10.

Herzenberg JE, Radler C, Bor N (2002) Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop 22(4):517–521PubMedCrossRef

11.

Adegbehingbe O, Oginni L, Ogundele J, Ariyibi AL, Abiola P, Ojo O (2010) Ponseti clubfoot management: changing surgical trends in Nigeria. Iowa Orthop J 30:7–14PubMedPubMedCentral

12.

Cooper DM, Dietz FR (1995) Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am 77(10):1477–89PubMedCrossRef

13.

Morcuende JA, Dolan LA, Dietz FR, Ponseti IV (2004) Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 113(2):376–380PubMedCrossRef

14.

Bensahela H, Kuo K, Duhaime M, G. International Clubfoot Study (2003) Outcome evaluation of the treatment of clubfoot: the international language of clubfoot. J Pediatr Orthop B 12(4):269–71PubMed

15.

Laaveg SJ, Ponseti IV (1980) Long-term results of treatment of congenital club foot. J Bone Joint Surg Am 62(1):23–31PubMedCrossRef

16.

McKay DW (1983) New concept of and approach to clubfoot treatment: section III–evaluation and results. J Pediatr Orthop 3(2):141–148PubMedCrossRef

17.

Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F (1995) Classification of clubfoot. J Pediatr Orthop B 4(2):129–136PubMedCrossRef

18.

Flynn JM, Donohoe M, Mackenzie WG (1998) An independent assessment of two clubfoot-classification systems. J Pediatr Orthop 18(3):323–327PubMedCrossRef

19.

Wainwright AM, Auld T, Benson MK, Theologis TN (2002) The classification of congenital talipes equinovarus. J Bone Joint Surg Br 84(7):1020–1024PubMedCrossRef

20.

Ayehualem S, Asmare Y, Abrha M, Muche A (2019) Prediction of number of casts and need of tenotomy using Pirani score in the management of clubfoot. J Craniofac Surg 30(5):e477–e481PubMedCrossRef

21.

Thometz JG, Simons GW (1993) Deformity of the calcaneocuboid joint in patients who have talipes equinovarus. J Bone Joint Surg Am 75(2):190–195PubMedCrossRef

22.

Bansal VP, Daniel J, Rai J (1988) Radiological score in the assessment of clubfoot. Int Orthop 12(3):181–185PubMedCrossRef

23.

Herbsthofer B, Eckardt A, Rompe JD, Küllmer K (1998) Significance of radiographic angle measurements in evaluation of congenital clubfoot. Arch Orthop Trauma Surg 117(6–7):324–329PubMedCrossRef

24.

Porter RW, Roy A, Rippstein J (1990) Assessment in congenital talipes equinovarus. Foot Ankle 11(1):16–21PubMedCrossRef

25.

Cook DA, Breed AL, Cook T, DeSmet AD, Muehle CM (1992) Observer variability in the radiographic measurement and classification of metatarsus adductus. J Pediatr Orthop 12(1):86–89PubMedCrossRef

26.

Thometz J, Manz R, Liu XC, Klein J, Manz-Friesth B (2009) Reproducibility of radiographic measurements in assessment of congenital talipes equinovarus. Am J Orthop (Belle Mead NJ) 38(12):617–620

27.

Radler C, Egermann M, Riedl K, Ganger R, Grill F (2010) Interobserver reliability of radiographic measurements of contralateral feet of pediatric patients with unilateral clubfoot. J Bone Joint Surg Am 92(14):2427–2435PubMedCrossRef

28.

Bhargava SK, Tandon A, Prakash M, Arora SS, Bhatt S, Bhargava S (2012) Radiography and sonography of clubfoot: a comparative study. Indian J Orthop 46(2):229–235PubMedPubMedCentralCrossRef

29.

Howard CB, Benson MK (1992) The ossific nuclei and the cartilage anlage of the talus and calcaneum. J Bone Joint Surg Br 74(4):620–623PubMedCrossRef

30.

Simons GW (1978) A standardized method for the radiographic evaluation of clubfeet. Clin Orthop Relat Res 135:107–118

31.

Bensahel H, Dimeglio A, Souchet P (1995) Final evaluation of clubfoot. J Pediatr Orthop B 4(2):137–141PubMedCrossRef

32.

Cummings RJ HR, McCluskey WP et al (1993) Can clubfeet be evaluated accurately and reproducibly? In: Simons GW (ed) The clubfoot: the present and a view of the future. Springer Verlag, New York, pp 104–113

33.

Ippolito E, Fraracci L, Farsetti P, De Maio F (2004) Validity of the anteroposterior talocalcaneal angle to assess congenital clubfoot correction. AJR Am J Roentgenol 182(5):1279–1282PubMedCrossRef

34.

Hamel J, Becker W (1996) Sonographic assessment of clubfoot deformity in young children. J Pediatr Orthop B 5(4):279–286PubMedCrossRef

35.

Suda R, Suda AJ, Grill F (2006) Sonographic classification of idiopathic clubfoot according to severity. J Pediatr Orthop B 15(2):134–140PubMedCrossRef

36.

Kuhns LR, Koujok K, Hall JM, Craig C (2003) Ultrasound of the navicular during the simulated Ponseti maneuver. J Pediatr Orthop 23(2):243–245PubMedCrossRef

37.

Tolat V, Boothroyd A, Carty H, Klenerman L (1995) Ultrasound: a helpful guide in the treatment of congenital talipes equinovarus. J Pediatr Orthop B 4(1):65–70PubMedCrossRef

38.

Desai S, Aroojis A, Mehta R (2008) Ultrasound evaluation of clubfoot correction during Ponseti treatment: a preliminary report. J Pediatr Orthop 28(1):53–59PubMedCrossRef

39.

Aurell Y, Johansson A, Hansson G, Jonsson K (2002) Ultrasound anatomy in the neonatal clubfoot. Eur Radiol 12(10):2509–2517PubMedCrossRef

40.

Pirani S, Zeznik L, Hodges D (2001) Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method. J Pediatr Orthop 21(6):719–726PubMedCrossRef

41.

Kamegaya M, Shinohara Y, Kuniyoshi K, Moriya H (2001) MRI study of talonavicular alignment in club foot. J Bone Joint Surg Br 83(5):726–730PubMedCrossRef

42.

Wang C, Petursdottir S, Leifsdottir I, Rehnberg L, Ahlström H (1999) MRI multiplanar reconstruction in the assessment of congenital talipes equinovarus. Pediatr Radiol 29(4):262–267PubMedCrossRef

43.

Downey DJ, Drennan JC, Garcia JF (1992) Magnetic resonance image findings in congenital talipes equinovarus. J Pediatr Orthop 12(2):224–228PubMedCrossRef

44.

O’Connor PJ, Bos CF, Bloem JL (1998) Tarsal navicular relations in club foot: is there a role for magnetic resonance imaging? Skeletal Radiol 27(8):440–444PubMedCrossRef

45.

El Hadi MH, Nurein MA, Bader M, Salih MMA, Babikir HE (2019) Radiological study of anatomical bony arrangement of the clubfoot deformity and its correlation with the Pirani clinical scoring system: a multicenter study. Sudan J Paediatr 19(2):101–109PubMedPubMedCentralCrossRef

46.

Sriharsha Y, Balaji G, Bharathi D, Patro DK (2020) Do the clinical scores (Pirani and Dimeglio scores) correlate with the radiological parameters in idiopathic club foot in infants? A cross-sectional study. J Pediatr Orthop B. https://doi.org/10.1097/BPB.0000000000000835

47.

Abulsaad M, Abdelgaber N (2008) Correlation between clinical outcome of surgically treated clubfeet and different radiological parameters. Acta Orthop Belg 74(4):489–495PubMed

48.

Fridman MW, de Almeida Fialho HS (2007) The role of radiographic measurements in the evaluation of congenital clubfoot surgical results. Skeletal Radiol 36(2):129–138PubMedCrossRef

Titel: Correlation of radiographic parameters with clinical correction in idiopathic congenital talipes equinovarus undergoing Ponseti treatment
verfasst von: Ahmad Addosooki
Hamdy Tammam
Ahmed Fawaz Morsy
Ashraf Marzouq
Emad H. Ahmed
Ahmed M. Ahmed
Elsayed Said
Publikationsdatum: 27.07.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 12/2021
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-021-05138-7

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Correlation of radiographic parameters with clinical correction in idiopathic congenital talipes equinovarus undergoing Ponseti treatment