Evaluation of Foot Bimalleolar Angle in the Management of Congenital Talipes Equinovarus

Abstract

The study was undertaken to establish the normal foot bimalleolar (FBM) angle in Indian infants and to correlate it with the severity of deformity and results of treatment in congenital talipes equinovarus (CTEV). Foot tracings with the level of both the malleoli of 182 feet (91 normal Indian infants) were taken. The anteromedial angle between the long axis of foot and the bimalleolar plane was taken as the FBM angle. The FBM angle in normal infants was calculated as 82.5 degrees. Eighty-four CTEV (51 patients) were clinically classified as grade I (five feet; FBM angle, 73.2 degrees), grade II (21 feet; FBM angle, 66.6 degrees), and grade III (58 feet; FBM angle, 54.7 degrees), depending on whether the foot could be passively corrected (grade I) or had a fixed equinus and/or varus of <20 degrees (grade II) or >20 degrees (grade III). Thirty-one feet (22 patients) were followed up prospectively after conservative (17 feet: grade I, three feet; grade II, three feet; grade III, 11 feet) and surgical release (all grade III, 14 feet). All feet with grade I and grade II deformity and 44% (11 feet) with grade III deformity were amenable to gentle graduated manipulations and cast application, whereas 56% (14 feet) with grade III deformity underwent soft tissue release. After nonsurgical treatment, the mean FBM angle was 82.3 degrees. Of the feet that underwent surgery, those with excellent (11 feet) and good correction (3 feet) had a mean FBM angle of 79.9 degrees and 74.3 degrees, respectively. There were no feet with fair or poor results. The clinical severity of foot deformity and results of treatment correlated well with the FBM angle. Foot tracing with the FBM angle is a simple, objective, and reproducible clinical criterion to classify the severity of foot deformity and evaluate the results of treatment.

Evaluation of Neglected Idiopathic Ctev Managed by Ligamentotaxis Using Jess: A Long-Term Followup

“…As far as analysis of FBA parameter is concerned, Jain et al [23] showed improvement from grade III to grade I in 93% of cases managed by Ponseti manipulation in early cases, while in present study we were able to bring FBA grade III to FBA grade I in 87.1% of our cases.…”

“…As described in the literature, the normal value of FBA is 82.5°. Feet were classified in groups I, II, III as per the Jain et al study [23] (group I: >73.2°, group II: >  66.6–73.2° and group III: <66.6°). FBA was recorded before and after the treatment.…”

Correlation of foot bimalleolar angle with Pirani score to assess the severity of congenital talipes equinovarus deformity

“…Jain et al [16] have used the FBM angle as an evaluation method and 82.51 was mean FBM found in normal Indian infants. Grade I, grade II, and grade III severity of club feet had mean FBM angles of 73.21, 66.61, and 54.71, respectively.…”

“…The improvement in the shape of the heel and forefoot is a measure of the correction of the calcaneal rotation [16]. In FBM, an attempt is made to use the foot print to quantify the CTEV deformity depending on the objective assessment of calcaneal rotation.…”

“…The various scores in vogue are Pirani score [10], Dimeglio score [11], Catterrall [12], and Harrold and Walker [13] classification. Jain et al [16] have used anteromedial foot bimalleolar angle (FBM) on a foot print and suggested it as an objective evidence of severity of club foot deformity and correction achieved. All these classifications are subjective in nature and have interobserver and intraobserver variation but they do not give objective evidence of the severity of deformity [6].…”