The ultrasonography evaluation of talar dysplasia as a potential prognostic factor for predicting the course and outcomes of clubfoot deformity treatment using Ponseti technique

Objective: The aim of this study was to assess the role of sonographic evaluation of Talar dysplasia inpredicting the outcome of standard Ponseti method in the treatment of clubfoot deformity.Methods: A total 23 children (15 boys and 8 girls; mean age: 18.2± 5.4 days (8e32)) who underwentPonseti treatment were included in the study. Before the treatment, maximal talus length of affected andnon-affected feet were measured by US and relative talar dysplasia ratio (RTDR) was calculated. Thepatients were categorized 2 groups according to RTDR: group Ae mild and group B e severe deformity.Pirani score was used for clinical evaluation. The groups were compared in terms of number of theapplied casts, need of percutaneous tenotomy of Achilles tendon (AchT) and frequency of deformityrecurrence.Results: Pirani score was 4.46 for population (4.33 for group A; 4.54 for group B). Number of castssigniŞcantly differed between groups (p < 0.001) and positive correlation was found (r ¼ 0.851,p< 0.001). AchT was performed in 56% cases for group A and in 86% cases for group B; no statisticallysigniŞcant difference was obtained (p ¼ 0.162). Recurrence occurred in 2 patients belonging to group Bwithout signiŞcant difference compared to group A (p ¼ 0.502).Conclusion: Talar dysplasia assessment appeared as a promising prognostic factor for predicting theoutcome of the Ponseti technique in treatment of clubfoot deformity.Level of evidence: Level IV, diagnostic study.

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1. Wynne-Davies R. Family studies and the cause of congenital club foot. Talipes equinovarus, talipes calcaneo-valgus and metatarsus varus. J Bone Jt Surg Br. 1964;46:445e463.

2. Ponseti IV. Treatment of congenital club foot. J Bone Jt Surg Am. 1992;74(3): 448e454.

3. Colburn M, Williams M. Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method. J Foot Ankle Surg. 2003;42(5):259e267.

4. Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop. 2002;22(4):517e521.

5. Lehman WB, Mohaideen A, Madan S, et al. A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop B. 2003;12(2):133e140.

6. Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classi fication of clubfoot. J Pediatr Orthop B. 1995;4(2):129e136.

7. Pirani S, Outerbridge H, Moran MBS. A Method of Evaluating Virgin Clubfoot with Substantial Interobserver Reliability. Miami: POSNA; 1995.

8. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Jt Surg Br. 2006;88(8):1082e1084.

9. Chu A, Labar AS, Sala DA, van Bosse HJ, Lehman WB. Clubfoot classification: correlation with Ponseti cast treatment. J Pediatr Orthop. 2010;30(7):695e699.

10. Howard CB, Benson MK. The ossific nuclei and the cartilage anlage of the talus and calcaneum. J Bone Jt Surg Br. 1992;74(4):620e623.

11. Miyagi N, Iisaka H, Yasuda K, Kaneda K. Onset of ossification of the tarsal bones in congenital clubfoot. J Pediatr Orthop. 1997;17(1):36e40.

12. Aurell Y, Andriesse H, Johansson A, Jonsson K. Ultrasound assessment of early clubfoot treatment: a comparison of the Ponseti method and a modified Copenhagen method. J Pediatr Orthop B. 2005;14(5):347e357.

13. Aurell Y, Johansson A, Hansson G, Jonsson K. Ultrasound anatomy in the neonatal clubfoot. Eur Radiol. 2002;12(10):2509e2517.

14. Hamel J, Becker W. Sonographic assessment of clubfoot deformity in young children. J Pediatr Orthop B. 1996;5(4):279e286.

15. Maiza D, Themar-Noel C, Legrand I, Bensahel H, Hassan M. Ultrasonographic approach to the neonatal foot: preliminary study. J Pediatr Orthop B. 1995;4(2): 123e128.

16. Chandrakanth U, Sudesh P, Gopinathan N, Prakash M, Goni VG. Tarsal bone dysplasia in clubfoot as measured by ultrasonography: can it be used as a prognostic indicator in congenital idiopathic Clubfoot? A prospective observational study. J Pediatr Orthop J Pediatr Orthop. 2016 Oct-Nov;36(7):725e729.

17. Abdelgawad AA, Lehman WB, van Bosse HJ, Scher DM, Sala Da. Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up. J Pediatr Orthop B. 2007;16(2):98e105.

18. 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):2306e2312.

19. 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):2495e2506.

20. Suda R, Suda AJ, Grill F. Sonographic classification of idiopathic clubfoot according to severity. J Pediatr Orthop B. 2006;15(2):134e140.

21. Desai S, Aroojis A, Mehta R. Ultrasound evaluation of clubfoot correction during Ponseti treatment: a preliminary report. J Pediatr Orthop. 2008;28(1):53e59.