Magnetic resonance angiography in clubfoot and vertical talus: a feasibility study.
Congenital vascular alterations of the normal adult arterial pattern have been associated with multiple congenital limb deformities including clubfoot and vertical talus. Investigators have observed absence of the anterior tibial artery and dorsalis pedis artery in most patients with clubfoot, and absence of the posterior tibial artery in all patients with vertical talus. We used magnetic resonance angiography to define the lower extremity vascular anatomy of two patients with left-sided vertical talus and right-sided clubfoot and one patient with bilateral vertical talus and cartilage-derived morphogenetic protein-1 (CDMP-1) gene mutation. Of the three patients, one had bilateral posterior tibial artery deficiencies while the other had bilateral anterior tibial artery deficiencies. The third patient with bilateral vertical talus and CDMP-1 mutation had normal arterial structure bilaterally. Though clubfoot and vertical talus have distinctly different clinical phenotypes, the association of each with arterial abnormalities suggests a common etiology during development. The presence of normal arterial structure in our patient with vertical talus and CDMP-1 mutation suggests that other nonvascular etiologies may be responsible for some cases of foot deformities.


METHODS
Level IV, prognostic case series. See the Guidelines for Authors for a complete description of levels of evidence.
Kruse
Lisa
L
Department of Orthopedic Surgery, Washington University School of Medicine, One Children's Place, Suite 4S60, St. Louis, MO 63110, USA.
Gurnett
Christina A
CA
Hootnick
David
D
Dobbs
Matthew B
MB
D000842:Ankle / Q000098:blood supply*; D003025:Clubfoot / Q000209:etiology / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D005532:Foot Deformities, Congenital / Q000209:etiology / Q000235:genetics / Q000473:pathology*; D020022:Genetic Predisposition to Disease; D055428:Growth Differentiation Factor 5 / Q000235:genetics; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D008297:Male; D009154:Mutation; D012307:Risk Factors; D013628:Talus / Q000098:blood supply*; D016909:Tibial Arteries / Q000002:abnormalities*; D054079:Vascular Malformations / Q000150:complications / Q000473:pathology*
C525893:GDF5 protein, human; D055428:Growth Differentiation Factor 5