Ultrasound anatomy in the normal neonatal and infant foot: an anatomic introduction to ultrasound assessment of foot deformities

Abstract

The aim of this study was to establish guidelines for US assessment of the talo-crural, the talo-navicular and the calcaneo-cuboid joints during the first year of life, which could serve as a reference while studying foot deformities. The feet of 54 healthy children were examined at birth and at the age of 4, 7 and 12 months by using three easily defined and reproducible US projections. With a medial projection the relation of the navicular in relation to the medial malleolus and the head of the talus was studied. A lateral projection revealed the calcaneo-cuboid relationship and a dorsal projection the talo-navicular alignment in the sagittal plane. Normal values for measurements of these cartilaginous relationships were established for the different age groups. Intra- and inter-observer reliability was assessed and found to be acceptable ( r=0.53-0.90, Pearson correlation coefficient). With US it is possible to obtain reproducible planes of investigation that give reliable information about the talo-crural, the talo-navicular and the calcaneo-cuboid relationships during the first year of life.

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

“…Calculating angles to describe the degree of clubfoot deformity, poses difficulty as the reliability of these measurements turns out to be too poor to be useful. 9 In MRI and CT studies with 3D modeling [27][28][29][30] this problem seems to be possible to overcome by a computer program determining the long axis of the talus and the calcaneus, but as the navicular and the cuboid by their shape escape any attempt to mathematically establish any long axis, this model could not be used to assess either the navicular or the cuboid displacement in mathematical terms. Therefore only angle (CC angle) which is easily reproducible is advocated by the author.…”

“…9 A different plane can be identified in real time by which varus component can be assessed by measuring distances between tuber calcanei and the lateral malleolus, while holding the heel first in a maximally corrected position and then in a maximally deformed position however, these examinations are too complicated and long lasting. In addition these distances vary according to the age group and cannot be used to create an objective classification system.…”

“…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.…”