Radiographic Indicators of Surgery and Functional Outcome in Ponseti-Treated Clubfeet. (May 2016)

• Record Type: Journal Article
• Authors: Shabtai, Lior; Hemo, Yoram; Yavor, Ariela; Gigi, Roy; Wientroub, Shlomo; Segev, Eitan
• Is Part Of: Foot & ankle international. Volume 37:Number 5(2016:May)
• Page Start: 542
• Page End: 547
• Publication Date: 2016-05
• Subjects: clubfoot -- Ponseti -- function -- surgery -- radiology; Foot -- Abnormalities -- Periodicals; Ankle -- Abnormalities -- Periodicals; Orthopedics -- Periodicals; 617.585
• DOI: 10.1177/1071100715623036
• Languages: English
• ISSNs: 1071-1007

Abstract

Background: Evaluation of the results of treatment for clubfoot by the Ponseti technique is based on clinical and functional parameters. There is a need to establish universally recognized quantitative measurements to compare, better understand, and more precisely evaluate therapeutic outcome. Methods: Nine angles were measured on standard radiographs of 145 children with idiopathic clubfeet treated between 2000 and 2010 with the Ponseti method. The average follow-up was 6.3 years. The need for additional surgery and the functional outcome was correlated to the radiologic measurements. Results: Three radiologic parameters were identified as having significant ( P ≤ .001) predictive value. The lateral tibiocalcaneal angle with the ankle at maximal dorsiflexion measuring fixed equinus was larger in the preoperated group (77 ± 12 degrees) compared to the nonoperated group (67 ± 14 degrees). Functional outcome was better with smaller angles. The lateral talocalcaneal angle with the ankle at maximal dorsiflexion measuring hindfoot rigidity was smaller (29 ± 8 degrees) in the preoperated group compared to the nonoperated group (35 ± 9 degrees). Functional outcome was better with larger angles. The lateral talo-first metatarsal angle with the ankle at maximal plantarflexion measuring foot cavus was larger in the preoperated group (31 ± 10 degrees) compared to the nonoperated group (22 ± 11 degrees), whereas functional outcome did not correlate with this angle. Conclusions: The lateral view with the foot in maximal dorsiflexion was found to be the most significant and useful view to detect abnormality in Ponseti-treated clubfeet. In our practice now, we are using only this view in order to reduce the radiation exposure to the child. Level of Evidence: Level III, retrospective case series.