Abstract
Background
US readily demonstrates cartilaginous structures, and static sonography has shown potential in evaluating clubfoot deformity.
Objective
To investigate the potential of dynamic sonography in the evaluation of the congenital clubfoot.
Materials and methods
Sonography was used for static and dynamic stress evaluation of 13 clubfeet and 35 normal feet in 24 patients (ages 0–32 weeks). Dynamic foot sonography was performed using a single-operator bimanual scanning technique. The examination involved coronal oblique evaluation of the medial malleolar–navicular (MMN) distance and the calcaneocuboid relationship, sagittal evaluation of the talonavicular relationship, and transverse evaluation of navicular subluxation, rotation, and deformation. Dynamic abduction/adduction stress maneuvers were performed, measured by the MMN.
Results
The clubfoot “gristle” is a consistent, measurable soft-tissue landmark in clubfeet, connecting the medial malleolus to the medial navicular and talus. Mean MMN distances in clubfeet in the neutral position and abduction were significantly different from these distances in the normal paired foot (differences of 8.7 mm neutral position and 7.94 mm abduction), as compared to bilateral normal feet (differences of 0.98 mm neutral position and 1.43 mm abduction). Navicular subluxation showed good correlation between highly deformed and subluxated navicular bones and a tight medial clubfoot complex.
Conclusions
Focused dynamic foot sonography is useful in providing a specific and detailed functional preoperative and/or postoperative assessment of the congenital clubfoot.
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References
Roye B, Hyman J, Roye D (2004) Congenital idiopathic talipes equinovarus. Pediatr Rev 25:124–130
Noonan K, Richards B (2003) Nonsurgical management of idiopathic clubfoot. J Am Acad Orthop Surg 11:392–402
Ippolito E (1995) Update on pathologic anatomy of clubfoot. J Pediatr Orthop B 4:17–24
Ponseti I (ed) (1996) Congenital clubfoot: fundamentals of treatment. Oxford University Press, Oxford, UK
Aurell Y, Adlercreutz C, Andriesse H et al (2004) Repeatability of sonographic measurements in clubfeet. Acta Radiol 45:622–627
Aurell Y, Johansson A, Hansson G et al (2002) Ultrasound anatomy in the normal neonatal and infant foot: an anatomic introduction to ultrasound assessment of foot deformities. Eur Radiol 12:2306–2312
Kuhns L, Koujok K, Hall J et al (2003) Ultrasound of the navicular during the simulated Ponseti maneuver. J Pediatr Orthop 23:243–245
Dobbs M, Morcuende J, Gurnett C et al (2000) Treatment of idiopathic clubfoot: an historical review. Iowa Orthop J 20:59–64
Dobbs M, Rudzki J, Purcell D et al (2004) Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am 86A:22–27
Morcuende J, Dolan L, Dietz F, Ponseti I (2004) Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 113:376–380
Herzenberg J, Radler C, Bor N (2002) Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop 22:517–521
Tolat V, Boothroyd A, Carty H et al (1995) Ultrasound: a helpful guide in the treatment of congenital talipes equinovarus. J Pediatr Orthop B 4:65–70
Simons G (1977) Analytical radiography of clubfeet. J Bone Joint Surg Br 59:485–488
Bansal V, Daniel J, Rai J (1988) Radiological score in the assessment of clubfoot. Int Orthop 12:181–185
Chami M, Daoud A, Maestro M et al (1996) Ultrasound contribution in the analysis of the newborn and infant normal and clubfoot: a preliminary study. Pediatr Radiol 26:298–302
Aurell Y, Johansson A, Hansson G et al (2002) Ultrasound anatomy in the neonatal clubfoot. Eur Radiol 12:2509–2517
Cahuzac J, Navascues J, Baunin C et al (2002) Assessment of the position of the navicular by three-dimensional magnetic resonance imaging in infant foot deformities. J Pediatr Orthop B 11:134–138
Pirani S, Zeznik L, Hodges D (2001) Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method. J Pediatr Orthop 21:719–726
Saito S, Hatori M, Kokubun S et al (2004) Evaluation of calcaneal malposition by magnetic resonance imaging in the infantile clubfoot. J Pediatr Orthop B 13:99–102
Gigante C, Talenti E, Turra S (2004) Sonographic assessment of clubfoot. J Clin Ultrasound 32:235–242
Maiza D, Themar-Noel C, Legrand I et al (1995) Ultrasonographic approach to the neonatal foot: preliminary study. J Pediatr Orthop B 4:123–128
Napiontek M (1995) Intraoperative ultrasound for evaluation of reduction in congenital talipes equinovarus. J Pediatr Orthop B 4:55–57
Hamel J, Becker W (1996) Sonographic assessment of clubfoot deformity in young children. J Pediatr Orthop B 5:279–286
Goldner J, Fitch R (1994) Classification and evaluation of congenital talipes equinovarus. In: Simons G (ed) The clubfoot. Springer, Berlin, pp 120–139
Tachdjian MO (ed) (1972) Pediatric orthopedics. Saunders, Philadelphia
Acknowledgements
The authors thank John Hayes, PhD, and Stacy Hoshaw-Woodard, PhD, for statistical support and analysis, and Brad Hoehne for the illustrations.
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Shiels, W.E., Coley, B.D., Kean, J. et al. Focused dynamic sonographic examination of the congenital clubfoot. Pediatr Radiol 37, 1118–1124 (2007). https://doi.org/10.1007/s00247-007-0581-3
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DOI: https://doi.org/10.1007/s00247-007-0581-3