ROLE OF ULTRASOUND AS PROGNOSTIC INDICATOR DURING PRONSETI CORRECTION
DOI:
https://doi.org/10.22159/ijcpr.2023v15i4.3023Keywords:
Sonographic, Club foot, Ponseti, SeverityAbstract
Objective: Clubfoot ultrasonography is an objective means of determining severity. The purpose of this study is to evaluate the reliability of measuring clubfoot severity by sonographic evaluation of the talonavicular angle (TNA) and the reliability of assessing angle change on simulated Ponseti manipulation.
Methods: Twenty-six infants with unilateral idiopathic clubfoot were evaluated prospectively using clinical scoring and Pirani scoring and sonographic measurements of TNA at the start of treatment, after midfoot correction, and after the complete correction was achieved. The TNA and its change during simulated Ponseti manipulation were recorded.
Results: In static posture, the mean TNA of the clubfoot (66.46°) differed substantially from that of the contralateral normal foot (101.3°). The mean shift in TNA after simulated Ponseti manipulation was 22.54° (5-50°), and it correlated negatively with clinical ratings and the total number of casts required for final correction (p<0.05). Linear regression research demonstrated that the change in TNA on simulated Ponseti manipulation was the strongest predictor of treatment outcome in CTEV (with a prediction of 60% compared to 25% for Pirani scores).
Conclusion: The severity of clubfoot in babies can be better accessed via sonographic examination of TNA and change in TNA following simulated Ponseti manipulation. This objective form of assessment is less expensive, more reproducible in clinical settings, and can better predict treatment outcomes.
Downloads
References
Tachdijian MO. Congenital talipes equinovarus in, Tachdjian pediatric orthopedics. Vol. 4. WB Saunders; 2008. p. 2428-56.
Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the ponseti method. Pediatrics. 2004;113(2):376-80. doi: 10.1542/peds.113.2.376. PMID 14754952.
Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B. 1995;4(2):129-36. doi: 10.1097/01202412-199504020-00002. PMID 7670979.
Pirani S. A method of assessing the virgin clubfoot. Paper presented at Peadiatric Orthpaedic Society of North America Orlando. USA 1995.
Howard CB, Benson MK. The ossific nuclei and the cartilage anlage of the talus and calcaneum. J Bone Joint Surg Br. 1992;74(4):620-3. doi: 10.1302/0301-620X.74B4.1624527, PMID 1624527.
Miyagi N, Iisaka H, Yasuda K, Kaneda K. Onset of ossification of the tarsal bones in congenital clubfoot. J Pediatr Orthop. 1997;17(1):36-40, PMID 8989699.
Kamegaya M, Shinohara Y, Kuniyoshi K, Moriya H. MRI study of talonavicular alignment in club foot. J Bone Joint Surg Br. 2001;83(5):726-30. doi: 10.1302/0301-620x.83b5.10936, PMID 11476314.
Aurell Y, Johansson A, Hansson G, Wallander H, Jonsson K. Ultrasound anatomy in the normal neonatal and infant foot: an anatomic introduction to ultrasound assessment of foot deformities. Eur Radiol. 2002;12(9):2306-12. doi: 10.1007/s00330-001-1243-8. PMID 12195486.
Aurell Y, Johansson A, Hansson G, Jonsson K. Ultrasound anatomy in the neonatal clubfoot. Eur Radiol. 2002;12(10):2509-17. doi: 10.1007/s00330-002-1326-1. PMID 12271392.
Kuhns LR, Koujok K, Hall JM, Craig C. Ultrasound of the navicular during the simulated Ponseti maneuver. J Pediatr Orthop. 2003;23(2):243-5. PMID 12604958.
Coley BD, Shiels WE, Kean J, Adler BH. Age-dependent dynamic sonographic measurement of pediatric clubfoot. Pediatr Radiol. 2007;37(11):1125-9. doi: 10.1007/s00247-007-0601-3, PMID 17846755.
Shiels WE, Coley BD, Kean J, Adler BH. Focused dynamic sonographic examination of the congenital clubfoot. Pediatr Radiol. 2007;37(11):1118-24. doi: 10.1007/s00247-007-0581-3. PMID 17846756.
Desai S, Aroojis A, Mehta R. Ultrasound evaluation of clubfoot correction during Ponseti treatment: a preliminary report. J Pediatr Orthop. 2008;28(1):53-9. doi: 10.1097/bpo.0b013e31815a60a6, PMID 18157047.
Harold AJ, Walker CJ. Treatment and prognosis in congenital clubfoot. J Bone Joint Surg. 1983;65B:8-11.
Lehman WB, Mohaideen A, Madan S, Scher DM, Van Bosse HJ, Iannacone M. A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop B. 2003;12(2):133-40. doi: 10.1097/01.bpb.0000049579.53117.4a, PMID 12584499
Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980;62(1):23-31. doi: 10.2106/00004623-198062010-00004, PMID 7351412.
Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am. 1995;77(10):1477-89. doi: 10.2106/00004623-199510000-00002, PMID 7593056.
Lloyd Roberts GC. Congenital clubfoot (Editorial and annotations). J Bone Joint Surg Br. 1964;46B:369-71.
George WS. Paper presented at the third Annual International Pediatric Orthopedic Seminar, Chicago, USA; May 28, 1975.
Hamel J, Becker W. Sonographic assessment of clubfoot deformity in young children. J Pediatr Orthop B. 1996;5(4):279-86. doi: 10.1097/01202412-199605040-00011, PMID 8897262.
Suda R, Suda AJ, Grill F. Sonographic classification of idiopathic clubfoot according to severity. J Pediatr Orthop B. 2006;15(2):134-40. doi: 10.1097/01.bpb.0000184951.85298.4f, PMID 16436950.
El-Adwar KL, Taha Kotb H. The role of ultrasound in clubfoot treatment: correlation with the Pirani score and assessment of the Ponseti method. Clin Orthop Relat Res. 2010;468(9):2495-506. doi: 10.1007/s11999-010-1335-3. PMID 20390471.
Ponseti IV. Congenital clubfoot fundamentals of treatment. Oxford, England: Oxford University Press; 1996. p. 68.
Published
How to Cite
Issue
Section
Copyright (c) 2023 NAVEEN GUPTA, AMIT THAKUR, DIXIT GAUTAM
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution 4.0 International License.