Ultrasound anatomy in the neonatal clubfoot

Abstract

Our objective was to assess clubfoot anatomy by US in newborn babies before and in the early phase of treatment. Reproducible US projections and measurements were carried out on 30 untreated clubfeet in 22 children, consecutively included in the study. The position of the navicular in relation to the head of the talus was visualised in all feet. The mean distance between the medial malleolus and the navicular was significantly shorter in the clubfeet than in normal feet. There was a tendency to medial displacement of the cuboid. Soft tissue thickness at the medial side of the foot was increased in all deformed feet. The measurements showed an acceptable intra- and inter-observer reliability for the different variables assessed ( r=0.71-0.96, Pearson's correlation coefficient). With US it is possible to obtain well-defined planes of investigation that give important information about the clubfoot deformity concerning the talo-crural, the talo-navicular and the calcaneo-cuboid joints. The method is simple enough to be used in everyday clinical practice and we recommend it as a guide during the non-operative treatment and for preoperative planning.

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

“…Generally, the nonossified cartilage gave a poor echo (black), whereas the ossification center of a bone showed a bright (white) echogenic focus within a cartilage matrix. Each foot was examined through three standard scanning projections (medial, lateral, and dorsal), as described by Aurell et al [5,6].…”

“…The validity of this clinical score could be reinforced if supplemented by sonographic assessment, before and after treatment, to confirm return of normal anatomic relationships between the different bones. In one study [5], numerous US variables were examined in clubfoot: the medial malleolus navicular distance; medial and sagittal displacement of the navicular in relation to the talar head; range of mobility of the talonavicular joint; thickness of the medial soft tissues; medial deviation of the talar neck; calcaneocuboid relationship; and length of the talus. Aurell et al recommended use of US as a guide during nonoperative treatment and for preoperative planning; however, they did not correlate US with clinical variables [5].…”

Ultrasonographic evaluation of clubfoot and it's correction by Ponseti method: a review

“…Lateral projection is obtained with probe at lateral border of foot lateral to its plantar aspect (Figure 6) as demonstrated by Aurell et al 8,9 and Calcaneo-Cuboid relationship can be visualized. A tangent is drawn along the lateral border of calcaneum and a perpendicular is drawn from the tangent to the lateral border of cuboid over the midpoint of ossification, this distance denotes CC distance.…”

“…The feet are examined through four standard projections (medial, dorsal, lateral and posterior) medial, dorsal, posterior projection as described by Aurell et al 8,9 and Posterior projection as described by Bhargava et al 18 Measurements are done by the radiologist defining the end points on sonographic monitor of the best images recorded in optimally correct position. There are various parameters that are assessed on dynamic sonography and these are dealt separately.…”

“…Various studies have been performed for sonographic examination of clubfoot. [6][7][8][9][10][11][12][13][14][15][16][17][18] Descriptive assessment of the alignment of various cartilaginous anlage, comparing clinical or radiological assessment with sonography, classification of the deformity. Work on quantification of the deformity either angular or linear, is limited.…”