Sonographic assessment of clubfoot

Gigante, Cosimo; Talenti, Enrico; Turra, S

doi:10.1002/jcu.20022

Cited by 34 publications

(20 citation statements)

References 19 publications

(19 reference statements)

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“…In the present study, mean C–C distance was found to be 3.4±2.0 mm in cases and 0.8±1 mm in controls as against a mean of 2.5±1.3 mm in cases and 1.0±1.1 mm in controls reported by Aurell et al .,8 the only author group to measure this. The C–C angle in the present study was 23.7°±10.24° in cases and 4°±6.6° in controls; Gigante et al 9. reported a mean of 20° in clubfoot and 10° in normal foot.…”

Section: Discussionsupporting

confidence: 41%

Radiography and sonography of clubfoot: A comparative Study

Tandon

Prakash

Arora

et al. 2012

IJOO

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Background:Congenital talipes equinovarus is a common foot deformity afflicting children with reported incidence varying from 0.9/1000 to 7/1000 in various populations. The success reported with Ponseti method when started at an early age requires an imaging modality to quantitate the deformity. Sonography being a radiation free, easily available non-invasive imaging has been investigated for this purpose. Various studies have described the sonographic anatomy of normal neonatal foot and clubfoot and correlated the degree of severity with trends in sonographic measurements. However, none of these studies have correlated clinical, radiographic and sonographic parameters of all the component deformities in clubfoot. The present study aims to compare the radiographic and sonographic parameters in various grades of clubfoot.Materials and Methods:Thirty-one children with unilateral clubfoot were examined clinically and graded according to the Demeglio system of classification of clubfoot severity. Antero-posterior (AP) and lateral radiographs of both normal and affected feet were obtained in maximum correction and AP talo-calcaneal (T-C), AP talo-first metatarsal (TMT) and lateral T-C angles were measured. Sonographic examination was done in medial, lateral, dorsal and posterior projections of both feet in static neutral position and after Ponseti manouever in the position of maximum correctability in dynamic sonography. Normal foot was taken as control in all cases. The sonographic parameters measured were as follows : Medial malleolar- navicular distance (MMN) and medial soft tissue thickness (STT) on medial projection, calcaneo-cuboid (C-C) distance, calcaneo-cuboid (C-C) angle and maximum length of calcaneus on lateral projection, length of talus on dorsal projection; and tibiocalcaneal (T-C) distance, posterior soft tissue thickness and length of tendoachilles on posterior projection. Also, medial displacement of navicular relative to talus, mobility of talonavicular joint (medial view); reducibility of C-C mal alignment (lateral view); talonavicular relation with respect to dorsal/ ventral displacement of navicular (dorsal view) and reduction of talus within the ankle mortise (posterior view) were subjectively assessed while performing dynamic sonography. Various radiographic and sonographic parameters were correlated with clinical grades.Results:MMN distance and STT measured on medial view, C-C distance and C-C angle measured on lateral view and tibiocalcaneal distance measured on posterior view showed statistically significant difference between cases and controls. A significant correlation was evident between sonographic parameters and clinical grades of relevant components of clubfoot. All radiographic angles except AP T-C angle were significantly different between cases and controls. However, they did not show correlation with clinical degree of severity.Conclusion:All radiographic angles except AP T-C angle and sonographic parameters varied significantly between cases and controls. However, radiographic pa...

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Section: Discussionsupporting

confidence: 41%

Radiography and sonography of clubfoot: A comparative Study

Tandon

Prakash

Arora

et al. 2012

IJOO

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“…Second, we were unable to assess the equinus deformity sonographically with the planes used. The value of US would be enhanced with use of a posterior projection [18,32] to predict the need and possibly the timing of tenotomy. Third, we did not assess interobserver variability as we had only one senior radiologist with sufficient experience in musculoskeletal US for the readings.…”

Section: Discussionmentioning

confidence: 99%

The Role of Ultrasound in Clubfoot Treatment: Correlation with the Pirani Score and Assessment of the Ponseti Method

El-Adwar¹,

Kotb²

2010

Clinical Orthopaedics &Amp; Related Research

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Background To evaluate neonates and infants with clubfoot, clinical and imaging modalities are required. Conventional radiography is of limited value because the studied bones are not fully ossified. Questions/purposes We attempted to (1) evaluate clinically and sonographically the reliability of the Ponseti method in correcting clubfeet; and (2) determine whether various ultrasound (US) variables correlated with each other and with the Pirani score before and after treatment. Methods We prospectively followed 17 infants (25 clubfeet) assessed using the Pirani score and US variables (medial malleolus navicular distance, navicular alignment in relation to the talar head, medial soft tissue thickness, talar length, and calcaneocuboid distance) and treated with the Ponseti method. The mean age of the patients at first casting was 30 days, and repeat assessment after treatment was performed at a mean age of 6.3 months. Patients were followed for a minimum of 0.75 months (mean, 14.1 months; range, 0.75-38 months). Results The Ponseti method corrected all feet. We found three clinical/US correlations. Before treatment, we observed a negative correlation between the clinical midfoot score and the sonographic medial malleolus navicular distance. After treatment we observed two negative correlations: one between the midfoot score and the sonographic talar length and the other between the hindfoot score and medial malleolus navicular distance. Four feet had recurrence of varus, two of which had an increased calcaneocuboid distance despite full restoration of navicular alignment in one foot.

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“…In the literature, most US studies are performed in neutral or spontaneous position of the foot and in maximal correction simulating the Ponseti maneuver [3,12,14,15,17,19,28]. Although dynamic US evaluation of the foot is of great clinical significance, we wish to emphasize the difficulty for a single operator to reach and maintain a reliable correction and to perform US examination simultaneously.…”

Section: Us Assessment Of Clubfootmentioning

confidence: 98%

“…Several authors have introduced the use of US for the evaluation of clubfoot and the quantification of the deformity [9][10][11][12][13][14][15][16][17][18][19]. US also has the potential to monitor the effects of treatment [20], which is mainly nonoperative (Ponseti technique) [21][22][23][24][25][26][27].…”

Section: Us Assessment Of Clubfootmentioning

confidence: 99%

Ultrasound evaluation of foot deformities in infants

Miron

Grimard

2015

Pediatr Radiol

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Foot deformity in infants is the most common congenital musculoskeletal condition. A precise diagnosis can sometimes be impossible to establish clinically. Radiologic imaging plays a major role in the evaluation of musculoskeletal abnormalities. However conventional imaging techniques, such as plain radiographs of the foot, are of very little help in this age group because of the lack of ossification of the tarsal bones. US presents a significant advantage because it permits the visualization of cartilaginous structures. This leads to the detailed assessment of foot deformities in infants. Furthermore, US can also be used as a dynamic imaging modality. Different scanning views are beneficial to evaluate the complete anatomy of the foot; depending on the suspected clinical diagnosis, some planes are more informative to display the pathological features of a specific deformity. We describe the US findings of five of the most common foot deformities referred to our pediatric orthopedic clinic (clubfoot, simple metatarsus adductus, skewfoot, and oblique and vertical talus). For each deformity we propose a specific imaging protocol based on US to provide an accurate diagnosis. US is a complementary tool to the clinical examination for determining the diagnosis and the severity of the deformity and also for monitoring the efficacy of treatment. Radiologists investigating foot deformities in infants should consider using US for the detailed assessment of the foot in this age group.

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Sonographic assessment of clubfoot

Abstract: Sonography is a promising technique for assessment and monitoring of clubfoot during treatment. The method described here yields accurate and reproducible information about the anatomy of the nonossified clubfoot, helping the orthopedic team decide on appropriate treatment steps.

Cited by 34 publications

References 19 publications

Radiography and sonography of clubfoot: A comparative Study

Radiography and sonography of clubfoot: A comparative Study

The Role of Ultrasound in Clubfoot Treatment: Correlation with the Pirani Score and Assessment of the Ponseti Method

Ultrasound evaluation of foot deformities in infants

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