Residual Equinus After the Ponseti Method: An MRI-based 3-Dimensional Analysis

Mitchell, Joseph; Bishop, Aaron; Feng, Yixuan; Farley, D.; Hetzel, Scott; Ploeg, Heidi‐Lynn; Nguyen, Jie C.; Noonan, Kenneth J.

doi:10.1097/bpo.0000000000001147

Cited by 14 publications

(8 citation statements)

References 13 publications

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“…The ideal patient for this technique is approximately 10 years old with equinus and radiographic features not amenable to soft tissue release (e.g., flat-top talus or dysmorphic changes in the talar neck) which could block dorsiflexion. 13 The epiphyseal height is measured to determine appropriate implants. Given often dysmorphic anatomy, a CT scan may be helpful for preoperative planning.…”

Section: Surgical Methodsmentioning

confidence: 99%

Anterior Hemi-epiphysiodesis of the Distal Tibia for Residual Equinus Deformity in Children with Clubfeet

Giertych¹,

Galli²,

Halanski³

et al. 2022

Journal of the Pediatric Orthopaedic Society of North America

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Background: Residual equinus deformity in toddlers with a history of clubfoot can be managed with soft tissue release, provided there is no articular incongruity. Distal tibia osteotomy is a reasonable choice in mature patients with a flattened talus provided the growth plate is closed. Anterior distal tibia hemi-epiphysiodesis is an option for children with articular incongruity who have substantial growth remaining. The aim of this study is to evaluate radiographic and clinical outcomes of this method. Methods: Fourteen clubfoot patients (20 ankles) with residual equinus deformity were treated between 2010-2015 with anterior distal tibial hemi-epiphysiodesis utilizing size appropriate modular plate and screw constructs. Patients were evaluated clinically and radiographically. Oxford Ankle Foot Questionnaire for Children (and caregivers) with supplemental questions were requested at most recent follow-up. Results: There were 12 males and 2 females, mean age 10 years at surgery (50-152 months), with the minimum 18 months of radiographic follow-up (Mean 34 months). Pre-surgical mean radiographic anterior distal tibial angle (ADTA) was 87.8 degrees (79-100) and mean maximum dorsiflexion was -5.7 degrees (-40-7). At follow-up, mean improvement of radiologic ADTA was 18 degrees and mean clinical dorsiflexion improvement was 8.4 degrees. On the Oxford Ankle Foot Questionnaire, children reported a mean functional score of 47% in the “Physical” domain, 71% in “School and Play”, 70% in “Emotional”, and 38% in footwear. Parents reported mean scores of 45% in Physical, 69% in School and Play, 56% in Emotional, and 28% in footwear. Sixty percent of parents reported increased foot flexibility, 80% noted improvement in their child’s walking, and 100% would choose this surgery again. Conclusions: Anterior distal tibial hemi-epiphysiodesis is a viable option for treatment of residual equinus in children with a clubfoot history and open growth plates. Radiographic improvement was at least 2x greater than the clinically measured improvements of dorsiflexion; yet each family would undergo the surgery again as they perceived an improvement in function.

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Section: Surgical Methodsmentioning

confidence: 99%

Anterior Hemi-epiphysiodesis of the Distal Tibia for Residual Equinus Deformity in Children with Clubfeet

Giertych¹,

Galli²,

Halanski³

et al. 2022

Journal of the Pediatric Orthopaedic Society of North America

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“…More details of the measurement process are described in another paper of the authors. 10 The arithmetic mean value and standard deviation of each geometric measurement were calculated for both groups. Two-tailed t-tests assuming unequal variances, without adjustment for multiplicity, were conducted between the two groups with the p \ 0.05 considered significant.…”

Section: Geometric Measurements On Three-dimensional Modelsmentioning

confidence: 99%

“…In previous studies, hindfoot morphology could not be accurately assessed by linear measurements from MRI data in this population. 1,[5][6][7][8][9][10] One limitation in some studies was the manually drawn axes and planes referred to in measurements, increasing the variance in the measurements. The subjectivity in the measurements reduced their reliability.…”

Section: Introductionmentioning

confidence: 99%

Statistical shape modelling to analyse the talus in paediatric clubfoot

Feng¹,

Bishop

Farley

et al. 2021

Proc Inst Mech Eng H

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One fifth of idiopathic clubfoot deformities cannot be fully corrected by Serial Ponseti casting and deformity recurs in 20%–30% of cases. To avoid x-ray exposure, the joints with largely unossified bones are diagnosed with magnetic resonance images (MRI). Typically, geometric measurements are made in the MRI planes; however, this method is inaccurate compared to measurements on three-dimensional (3D) models of the joint. More accurate measurements using the 3D bone shapes may be better at identifying differences between groups; and therefore, improve diagnosis. The entire set of shape features from MRI can be analysed simultaneously through statistical shape modelling (SSM) which assesses bone morphology of clubfoot in a more sensitive way. A method for SSM of the talus is developed in this study and the shape of the normal talus is compared with the one in clubfeet with residual deformity through both geometric measurements and SSM. Significant differences between two groups were found by both methods; and therefore, might contribute to improve diagnosis of clubfoot.

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“…Posteriormente, con el manejo a través del método de Ponseti, puede haber deformidades residuales, entre ellas el equino (el más común), que se observa de 20 a 30% de los casos. 7,8 Hasta el momento, han sido descritos cinco patrones de recaída, a saber: la disminución de la dorsiflexión (menor a 15 grados), supinación del antepié, el equino rígido, la abducción rígida del antepié y del mediopié y la combinación de éstos. 8…”

Section: Introductionunclassified

“…7,8 Hasta el momento, han sido descritos cinco patrones de recaída, a saber: la disminución de la dorsiflexión (menor a 15 grados), supinación del antepié, el equino rígido, la abducción rígida del antepié y del mediopié y la combinación de éstos. 8…”

Section: Introductionunclassified