Stress radiography in the assessment of residual deformity in clubfoot following postero-medial soft tissue release

Abstract

X-ray is important in the assessment of clubfoot. Stress radiographs give more information than routine radiographs. Because of the inaccuracy of the positioning and the disadvantages of radiation, paediatric orthopaedic surgeons do not like and do not use X-ray examination. In this study we report a technique we use to obtain stress radiographs in paediatric patients with clubfoot using a custom-made radiolucent modular splint. This technique provides better assessment of the initial status and the result of treatment. Although this method has limitations it can help to compare different feet and treatment results with regard to axis and angle. We validated this splint by means of a prospective study in 11 patients with 21 feet having type 2 clubfoot who underwent (PMSTR) in our centre. Two sets of radiographs were taken, one with manual positioning and one with our splint. We found significant differences in the values of midfoot and forefoot radiological parameters between the two sets. We found that the correlation between the clinical and radiological assessment of residual deformity improved significantly for these values when a splint was used to obtain stress views. Hence we recommend routine use of a radiolucent splint for taking stress views to assess residual deformity in clubfoot.Résumé Les radiographies sont un élément important dans l'analyses des pieds bots, les radiographies dynamiques donnant plus d'informations que les radiographies standards.Cependant, les chirurgiens orthopédistes n'aiment pas utiliser les radiographies dynamiques, celles-ci entraînent une exposition plus importante aux rayons. Au cours de cette étude, nous rapportons une technique permettant d'obtenir ces clichés dynamiques en utilisant une attelle modulaire, transparente aux rayons X. Cette technique permet de faire une meilleure analyse des stades initiaux de la maladie et des résultats du traitement. Cependant,cette technique a égale-ment ses limites. Néanmoins, elle permet de comparer les résultats des différents pieds et des différents traitements en terme d'analyse des axes et d'analyse angulaire. Nous avons validé l'utilisation de cette attelle lors d'une étude prospective chez 11 patients présentant 21 pieds bots de type 2 qui ont bénéficié d'une PMSTR en notre centre. Des radios dynamiques ont été pratiquées, soit en utilisant l'attelle, soit en radio dynamique manuelle. Nous avons trouvé une différence significative dans les valeurs du médio-pied et de l'arrière-pied, lorsque les clichés dynamiques ont utilisé l'attelle en comparaison avec les examens dynamiques manuels. Nous avons également trouvé une meilleure corrélation entre les résultats cliniques et radiologiques de la déformation résiduelle lorsque l'on utilisait l'attelle. Aussi, recommandons-nous d'utiliser cette attelle radio-transparente, en routine habituelle, pour les clichés dynamiques a fin d'analyser les déformations résiduelles dans le pied bot.

Club Foot After Treatment

“…Size of wedge is measured according to predetermined amount of cuboid to correct the fore foot adduction. 28 There are several limitation of this study since it is a single center study with a limited sample size, there are chances of bias in patient selection.…”

“…9 However the results are far superior as compared to surgical treatment with respect to deformity correction, prevention of overcorrection and markedly improved functional outcome. 10 Relapse by most authors is defined as "any foot following successful correction with ponseti technique, requiring further intervention to correct the deformity". 11,12 Some authors have used the Pirani or Dimeglio score to rate the relapses.…”

Club Foot After Treatment;

“…Size of wedge is measured according to predetermined amount of cuboid to correct the fore foot adduction. 28 There are several limitation of this study since it is a single center study with a limited sample size, there are chances of bias in patient selection. Children who were treated previously elsewhere to be included in this study the possibility of partial correction at initial treatment cannot be ruled out because to differentiate between incomplete correction and true relapse is difficult.…”

Midterm results following revision surgery in clubfeet

“…The relapse rate of surgically treated clubfeet is about 25% (range, 13-50%) [2]. Forefoot and midfoot deformities are the most common persistent deformities [21]. According to Tarraf and Caroll, residual forefoot adduction and supination are present in 95% of residual clubfeet [24].…”