Neonatal foot deformities and their relationship to developmental dysplasia of the hip: an 11-year prospective, longitudinal observational study.
In a prospective study over 11 years we assessed the relationship between neonatal deformities of the foot and the presence of ultrasonographic developmental dysplasia of the hip (DDH). Between 1 January 1996 and 31 December 2006, 614 infants with deformities of the foot were referred for clinical and ultrasonographic evaluation. There were 436 cases of postural talipes equinovarus deformity (TEV), 60 of fixed congenital talipes equinovarus (CTEV), 93 of congenital talipes calcaneovalgus (CTCV) and 25 of metatarsus adductus. The overall risk of ultrasonographic dysplasia or instability was 1:27 in postural TEV, 1:8.6 in CTEV, 1:5.2 in CTCV and 1:25 in metatarsus adductus. The risk of type-IV instability of the hip or irreducible dislocation was 1:436 (0.2%) in postural TEV, 1:15.4 (6.5%) in CTCV and 1:25 (4%) in metatarsus adductus. There were no cases of hip instability (type IV) or of irreducible dislocation in the CTEV group. Routine screening for DDH in cases of postural TEV and CTEV is no longer advocated. The former is poorly defined, leading to the over-diagnosis of a possibly spurious condition. Ultrasonographic imaging and surveillance of hips in infants with CTCV and possibly those with metatarsus adductus should continue.
Paton
R W
RW
Department of Orthopaedics, Royal Blackburn Hospital, Haslingden Road, Blackburn, UK.
Choudry
Q
Q
D001848:Bone Diseases, Developmental / Q000453:epidemiology* / Q000517:prevention & control; D005532:Foot Deformities, Congenital / Q000453:epidemiology*; D006618:Hip Dislocation, Congenital / Q000453:epidemiology* / Q000517:prevention & control; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008137:Longitudinal Studies; D015997:Neonatal Screening / Q000379:methods; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation; D012307:Risk Factors; D014463:Ultrasonography; D006113:United Kingdom / Q000453:epidemiology