Quantification of the ossification of the lateral cuneiform in the feet of young children with unilateral congenital talipes equinovarus

Lang, Pamela J.; Avoian, Tigran; Sangiorgio, Sophia N.; Nazif, Mohammad A.; Ebramzadeh, Edward; Zionts, Lewis E.

doi:10.1302/0301-620x.99b8.bjj-2016-0999.r2

Cited by 9 publications

(13 citation statements)

References 21 publications

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“…The procedure is generally recommended for patients older than 2.5 years of age as it was presumed that by this age, sufficient ossification had occurred in the third cuneiform to allow bone-to tendon healing and avoid damage to the cartilaginous anlage (25). To quantify the ossification process of the lateral cuneiform between 1 and 3 years of age, we measured the length, width, and height of this osseous structure in 43 consecutive patients in our clubfoot clinic with a unilateral idiopathic clubfoot deformity (50). We observed that the dimensionslength, height, and width-on the affected side increased annually, but remained smaller than the corresponding dimensions of the unaffected foot (P<0.01).…”

Section: When Is the Third Cuneiform Ossification Center Large Enough For Tendon Transfer?mentioning

confidence: 93%

Objective analysis of intermediate-term outcome of the Ponseti technique: a review of the experience from Los Angeles

Zionts¹,

Ebramzadeh²,

Sangiorgio³

2021

Ann Transl Med

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The Ponseti method of manipulative treatment for clubfoot deformity became widely adopted by pediatric orthopaedic surgeons beginning in the mid-1990s. The technique allows correction of most idiopathic clubfeet using gentle manipulation and cast application. The treatment represents a marked advance over past efforts to gain correction of the foot through extensive release surgery. In 2006, we began a Clubfoot Clinic at the Orthopaedic Institute for Children in Los Angeles, California dedicated to managing clubfoot patients using Ponseti's method. An IRB-approved database of patient-related, treatment related, and demographic variables was assembled and used to ascertain the outcome of treatment as well as to address parental questions regarding certain aspects of treatment. Here, we present a review of our body of work, which has improved clinical decision making as well as our ability to better inform our patients' parents regarding the treatment and prognosis of the Ponseti method. Studies from our institution showed that while relapses and the need for extra-articular tibialis anterior tendon transfer (TATT) surgery remain common to the Ponseti method, these events do not adversely affect overall patient function or satisfaction. These findings were not unlike those of classic studies reported from Ponseti's institution. We conclude that the Ponseti method is not only a technique to achieve initial correction of an idiopathic clubfoot, but also how to manage relapses that will inevitably occur in many patients. While relapses and tendon transfer surgery are likely to remain common with this treatment method, these events do not adversely affect overall patient function or satisfaction. The parents of infants whose clubfeet are managed using the Ponseti method should be counselled accordingly.

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Section: When Is the Third Cuneiform Ossification Center Large Enough For Tendon Transfer?mentioning

confidence: 93%

Objective analysis of intermediate-term outcome of the Ponseti technique: a review of the experience from Los Angeles

Zionts¹,

Ebramzadeh²,

Sangiorgio³

2021

Ann Transl Med

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“…A cuneiform evaluation in CF patients was done recently by Lang et al 9 who evaluated the length, width and height of the lateral cuneiform using standardized anteroposterior and lateral radiographs showing that the lateral cuneiform on the affected side increased annually in all dimensions but remained smaller than the corresponding dimensions of the unaffected foot. This correlates with previous findings of delayed ossification of the cuneiform bone in the congenital CF 29 (Fig.…”

Section: Evidence On the Dysplastic Nature Of Tarsal Bonesmentioning

confidence: 99%

“…There is a certain percentage of abnormal delay in the appearance of ossification in cases which experienced a relapse of the deformity and had a corrective operation. The ossification process of the lateral cuneiform in children with CF treated using the Ponseti method was studied by Lang et al 9 They have demonstrated that although the lateral cuneiform is growing in all dimensions during the follow-up period, it remained smaller than the unaffected side.…”

Section: Evidence On the Dysplastic Nature Of Tarsal Bonesmentioning

confidence: 99%

Delayed ossification and abnormal development of tarsal bones in idiopathic clubfoot: Should it affect bracing protocol when using the Ponseti method?

Hemo

Gigi

Wientroub

2019

Journal of Children's Orthopaedics

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Purpose To point out the need to take into account the dysplastic nature of tarsal bones when treating idiopathic clubfoot (CF). Methods Review the published evidence on the developmental abnormalities of tarsal bones in idiopathic CF. Results The literature review provides abundant proof of the existence of delayed appearance and slower development of ossification centres of tarsal bones in idiopathic clubfoot. Conclusion Gentle manipulations and casting are the cornerstone of the Ponseti method. The biological response of all foot elements is critical for a successful outcome. Delayed ossification and abnormal development of tarsal bones in idiopathic CF may affect the results. Development of a personalized tailored bracing protocol based on severity assessment and response to casting treatment will improve results and quality of care in CF management. Level of Evidence V

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“…Delayed development and ossification process of the tarsal bones in CF has been shown in many studies 14-20 to have resulted in a smaller foot size. Furthermore, the three muscle compartments of the CF leg are shorter and thinner than normal in unilateral CF compared with the unaffected side 21 while the leg muscular atrophy is a primitive pathological component of CF and is present at an early stage of foetal development.…”

Section: Introductionmentioning

confidence: 99%

“…The significance of foot length at the initiation of the Ponseti method: a prospective study Organization 9 as a simple approach to identify preterm babies. It was shown that postnatal FL measurements can accurately determine GA. [10][11][12][13] Delayed development and ossification process of the tarsal bones in CF has been shown in many studies [14][15][16][17][18][19][20] to have resulted in a smaller foot size. Furthermore, the three muscle compartments of the CF leg are shorter and thinner than normal in unilateral CF compared with the unaffected side 21 while the leg muscular atrophy is a primitive pathological component of CF and is present at an early stage of foetal development.…”

Section: Introductionmentioning

confidence: 99%

The significance of foot length at the initiation of the Ponseti method: A prospective study

Hemo

Yavor

Gigi

et al. 2019

Journal of Children's Orthopaedics

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Objectives We sought to evaluate foot length (FL) and forefoot circumference (FC) and their impact on the severity of idiopathic clubfoot (CF) and results of treatment. We hypothesized that a smaller foot size at birth that represents a lesser than term newborn may affect the response of the CF to the treatment. Methods We conducted a prospective study documenting FL and FC of all neonates presented with idiopathic CF. Additional demographic information was collected. Outcome measures were number of casts needed for correction, need for recasting, additional surgery and functional score. Results In all, 52 children with 73 CF with a minimum mean follow-up of two years (2.0 to 5.6; sd 1.08) were evaluated. Mean gestational age was 38.63 weeks and mean birth weight (BW) was 3184 g. The mean FL at presentation was 74 mm (5.70 to 9.00), initial Pirani score was 5.5 (2.5 to 6.0) while number of casts was 6.9 (4.0 to 11.0). The FL was significantly correlated both to initial Pirani score (r = -0.35; p < 0.01) and number of casts (r = -0.33; p < 0.05). Positive correlation was found between the number of casts to Pirani score and number of additional procedures (r = 0.39; r = 0.36; p < 0.01, respectively). A foot size of up to 8 cm, needed 7.3 casts (4 to 7) compared with a FL of 8 cm or longer who needed 4.7 casts (4 to 6; t = 7.11; p < 0.001). Conclusion FL is a simple approach to identify preterm babies. It can be used as part of the initial evaluation of CF and help in predicting the course of treatment. We recommend adding FL to the existing classification. Level of Evidence I - Prognostic study

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Quantification of the ossification of the lateral cuneiform in the feet of young children with unilateral congenital talipes equinovarus

Abstract: At one and two years, the ossification centre of the lateral cuneiform may not be large enough to accommodate a drill hole for tendon transfer. However, by three years, it has undergone sufficient ossification to do so. Cite this article: 2017;99-B:1109-14.

Cited by 9 publications

References 21 publications

Objective analysis of intermediate-term outcome of the Ponseti technique: a review of the experience from Los Angeles

Objective analysis of intermediate-term outcome of the Ponseti technique: a review of the experience from Los Angeles

Delayed ossification and abnormal development of tarsal bones in idiopathic clubfoot: Should it affect bracing protocol when using the Ponseti method?

The significance of foot length at the initiation of the Ponseti method: A prospective study

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