J Korean Orthop Assoc.  2019 Feb;54(1):59-66. 10.4055/jkoa.2019.54.1.59.

Reliable Radiologic Parameters to Predict Surgical Management for Clubfoot Treated with the Ponseti Method

• Song KS
• Yon CJ
• Lee SW
• Lee YH
• Um SH
• Kwon HJ

• KMID: 2438965
• DOI: http://doi.org/10.4055/jkoa.2019.54.1.59

Abstract

PURPOSE
Several radiologic reference lines have been used to evaluate individuals with a clubfoot but there is no consensus as to which is most reliable. The aim of this study was to identify which radiologic parameters have relevance to the predictability of additional surgery after Ponseti casting on clubfoot and the effect of clubfoot treatments that contain Ponseti casting and additional surgery.
MATERIALS AND METHODS
A total of 102 clubfeet (65 patients, 37 bilateral) were reviewed from 2005 to 2013. The patients were divided into two groups (Group A, those for whom the result of the Ponseti method was successful and did not require additional surgery; and Group B, those for whom the result of the Ponseti method was unsuccessful and required additional surgery), and the following parameters were measured on the plain radiographs: i) talo-calcaneal angle on the anteroposterior and lateral view, ii) talo-1st metatarsal angle on the anteroposterior view, and iii) Tibio-calcaneal angle on the lateral view with the ankle full-dorsiflexion state. Each radiograph was reviewed on two separate occasions by one orthopedic doctor to characterize the intra-observer reliability, and the averages were analyzed. Next, 20 cases were chosen using a random number table, and two orthopedic doctors measured the angle separately to characterize the inter-observer reliability.
RESULTS
Groups A and B included 73 clubfeet (71.6%) and 29 clubfeet (28.4%), respectively. The initial talo-calcaneal angle and tibio-calcaneal angle in the lateral view were significantly different among the groups. In addition, inter- and intra-observer biases were not detected. The talo-1st metatarsal angle on the anteroposterior view and tibio-calcaneal angle on the lateral view were significantly different after treatment in both groups.
CONCLUSION
Congenital clubfeet treated with the Ponseti method showed successful results in more than 70% of patients. The initial talo-calcaneal angle and tibio-calcaneal angle on the lateral view were the radiologic parameters that could predict the need for additional surgical treatments. The talo-1st metatarsal angle on the anteroposterior view and tibio-calcaneal angle on the lateral view could effectively evaluate the changes in clubfoot after treatment.

Keyword

clubfoot; Ponseti method

MeSH Terms

Ankle
Bias (Epidemiology)
Clubfoot*
Consensus
Humans
Metatarsal Bones
Methods*
Orthopedics

Figure

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  Figure 1 (A) Talo-calcaneal angle on the anteroposterior view. (B) Talo-1st metatarsal angle on the anteroposterior view. (C) Talo-calcaneal angle on the lateral view. (D) Tibio-calcaneal angle on the lateral view.

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