Ultrasound Examination in Infant Clubfoot with Special Emphasis on the Talonavicular and the Calcaneocuboid Joints
Abstract: The purpose of the study was to develop an ultrasound (US) protocol for evaluating congenital clubfoot pathoanatomy before and during early treatment. By using 3 easily defined and reproducible US projections the talonavicular and the calcaneocuboid joints were assessed. Normal configurations of the relationships at these joints were obtained by investigating 54 healthy babies at the ages of 0, 4, 7 and 12 months. Variations in clubfoot pathoanatomy before treatment are described in 22 children with 30 clubfeet. Morphological changes taking place during early clubfoot treatment were assessed by following two differently treated groups of clubfeet with US and clinical investigations in the neonatal period, after 2-3 months of non-surgical treatment and 1-2 months post-surgically. Seven children (9 clubfeet, Group A) were treated with the Ponseti method with serial casting and 14 children (19 clubfeet, Group B) were treated with an adjustable plexidur splint and intensive physiotherapy (the Copenhagen method). Intra- and inter-observer agreement was assessed by two investigators examinating 17 clubfeet by US independently. The clubfeet showed medial displacement of the navicular, significant shorter medial malleolus-navicular distance (MM-N distance), and medial displacement of the cuboid compared with controls. After 2-3 months of non-surgical treatment the MM-N distance had increased significantly more in the Group A feet. The Group B feet required more extensive surgery (posterior or posteriomedial release in 13 feet) to obtain the same degree of correction as the Group B feet (tenotomy of the Achilles tendon). Inter-observer agreement expressed as kappa values were 0.70 for navicular displacement, 0.68 for talar head pointing laterally and 0.36 for medial deviation of the talar head, 1.00 indicating full agreement and 0.00 representing random agreement. Conclusions: Important aspects of clubfoot pathoanatomy can reliably be evaluated using US. Ultrasound can play an important role in the treatment of clubfoot in monitoring and evaluating the effects of treatment. It can also be used as an aid in teaching.
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