Congenital isolated clubfoot: Correlation between prenatal assessment and postnatal degree of severity

Abstract

Objective: Since prenatal diagnosis of isolated clubfoot has a false positive rate (FP) of 10%-40%, fetal parameters that might correlate with post-natal confirmation and grade of severity were investigated. Method: Retrospective analysis (2013-2019) of cases analysed with threedimensional multiplanar view. The following data were recorded: the angle between the long axis of foot and lower leg; width, length and width-to-length ratio (W/L) of the foot; tibia length and calf width (T/C) ratio. Severity after birth was assessed using the Pirani classification. Results: Diagnosis was confirmed in 45/53 neonates (84.9%, FP 15%). Values were higher for both angle and W/L in true vs false positive cases (median angle 100.4 versus 69.55 , p <.000; median W/L 0.53 vs 0.45, p = .001), no difference for T/C (3.77 vs 3.48, p = .8). The area under the curve for angle was 0.98 (CI 0.94-1.00), with a diagnostic cutoff of 84.7 (PPV of 100%, NPV of 66.7%). Median Pirani score, available for 33 neonates (73.3%) was 3 (IQR 3-4): only angle correlated with Pirani score (Spearman coefficient 0.36, p = .04) Conclusion: Measuring the angle between the foot and lower leg can reduce the FP rate of prenatal congenital clubfoot diagnosis and better predict the need for postnatal treatment.

Prenatal Diagnosis of Clubfoot: Where Are We Now? Systematic Review and Meta-Analysis

“…The 23 selected studies included a total of 2318 patients who were prenatally diagnosed with clubfoot by US and/or MRI, some included karyotyping through amniocentesis and/or CVS. 11 of the studies included information about whether or not the diagnosis was confirmed after birth (accuracy) [ 1 , 10 , 11 , 12 , 13 , 14 , 16 , 22 , 23 , 25 , 27 ], the rest of the studies were used to obtain information about the main methodology used for prenatal diagnosis of clubfoot, but did not provide any detail about its accuracy; therefore, this item was not assessed. The minimum age was the first trimester of pregnancy (the week was not specified) [ 8 , 18 , 23 , 25 , 26 ] while the maximum reported age was 28 weeks of pregnancy [ 20 ].…”

“…The final studies selected by the reviewers included the following levels of evidence: 19 level III retrospective studies [ 1 , 2 , 7 , 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 21 , 22 , 25 , 26 , 27 ], 3 level II prospective comparative studies [ 8 , 11 , 20 ], 1 descriptive study of level III [ 19 ] ( Table 1 ).…”

“…A total of 13 of the studies specified the timing at which the diagnosis was made [ 7 , 8 , 13 , 16 , 18 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Of the 13 studies that specified timing of diagnosis, 5 included diagnosis during trimester 1 [ 8 , 18 , 23 , 25 , 26 ], and this was the minimum age of diagnosis reported.…”

Clubfoot management in the Middle East: a survey-based review

“…Raising awareness about clubfeet among our colleagues gynecologists in the Middle East is still needed, especially that screening for clubfoot and possible associated conditions is feasible (4,52,53). Available evidence suggests that false positive rate can be lowered to around 10% if the diagnosis is performed in the second trimester (54,55). This is of paramount importance as parents can be prepared for the diagnosis, and counselled for the disease, the presence (or not) of associated conditions and the path of the treatment, before birth of their awaited child (54,56).…”

“…Available evidence suggests that false positive rate can be lowered to around 10% if the diagnosis is performed in the second trimester (54,55). This is of paramount importance as parents can be prepared for the diagnosis, and counselled for the disease, the presence (or not) of associated conditions and the path of the treatment, before birth of their awaited child (54,56). They will also be oriented to seek care as soon as possible after birth increasing the chance of presenting optimal care for their children (52,53,56).…”