title: The role of ultrasound in clubfoot treatment: correlation with the Pirani score and assessment of the Ponseti method.
abstract: BACKGROUND
  To evaluate neonates and infants with clubfoot, clinical and imaging modalities are required. Conventional radiography is of limited value because the studied bones are not fully ossified.
  
  
  OBJECTIVE
  We attempted to (1) evaluate clinically and sonographically the reliability of the Ponseti method in correcting clubfeet; and (2) determine whether various ultrasound (US) variables correlated with each other and with the Pirani score before and after treatment.
  
  
  METHODS
  We prospectively followed 17 infants (25 clubfeet) assessed using the Pirani score and US variables (medial malleolus navicular distance, navicular alignment in relation to the talar head, medial soft tissue thickness, talar length, and calcaneocuboid distance) and treated with the Ponseti method. The mean age of the patients at first casting was 30 days, and repeat assessment after treatment was performed at a mean age of 6.3 months. Patients were followed for a minimum of 0.75 months (mean, 14.1 months; range, 0.75-38 months).
  
  
  RESULTS
  The Ponseti method corrected all feet. We found three clinical/US correlations. Before treatment, we observed a negative correlation between the clinical midfoot score and the sonographic medial malleolus navicular distance. After treatment we observed two negative correlations: one between the midfoot score and the sonographic talar length and the other between the hindfoot score and medial malleolus navicular distance. Four feet had recurrence of varus, two of which had an increased calcaneocuboid distance despite full restoration of navicular alignment in one foot.
  
  
  CONCLUSIONS
  US can play a role in clubfoot assessment and may alert the surgeon to feet that may be prone to recurrence.
  
  
  METHODS
  Level II, prospective study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Hadra Orthopaedic University Hospital, Lambrouso, Alexandria,Egypt. khaled_eladwar@yahoo.com
authors.forename: Khaled Loutfy
authors.initials: KL
authors.lastname: El-Adwar
authors.forename: Hesham
authors.initials: H
authors.lastname: Taha Kotb
mesh_terms: D002111:Calcaneus / Q000002:abnormalities / Q000000981:diagnostic imaging; D002370:Casts, Surgical; D003025:Clubfoot / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005529:Foot Bones / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D013628:Talus / Q000002:abnormalities / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D014463:Ultrasonography
references.citation: J Bone Joint Surg Br. 2006 Aug;88(8):1082-4
references.pmid: 16877610
references.citation: Eur Radiol. 2002 Oct;12(10):2509-17
references.pmid: 12271392
references.citation: J Bone Joint Surg Br. 2006 Oct;88(10):1385-7
references.pmid: 17012432
references.citation: J Bone Joint Surg Br. 1999 Jan;81(1):97-101
references.pmid: 10068013
references.citation: J Bone Joint Surg Am. 2009 Jun;91(6):1350-9
references.pmid: 19487512
references.citation: J Bone Joint Surg Am. 1980 Jan;62(1):23-31
references.pmid: 7351412
references.citation: J Bone Joint Surg Br. 1992 Jul;74(4):620-3
references.pmid: 1624527
references.citation: J Pediatr Orthop B. 2006 Mar;15(2):134-40
references.pmid: 16436950
references.citation: J Pediatr Orthop B. 1995;4(2):123-8
references.pmid: 7670978
references.citation: J Pediatr Orthop B. 1995;4(2):129-36
references.pmid: 7670979
references.citation: J Pediatr Orthop B. 1996 Fall;5(4):279-86
references.pmid: 8897262
references.citation: J Pediatr Orthop. 1998 May-Jun;18(3):323-7
references.pmid: 9600557
references.citation: Pediatr Radiol. 1996;26(4):298-302
references.pmid: 8677151
references.citation: J Pediatr Orthop. 1992 Mar-Apr;12(2):207-16
references.pmid: 1552024
references.citation: South Med J. 1976 Aug;69(8):1037-8
references.pmid: 959868
references.citation: J Pediatr Orthop B. 2006 Jan;15(1):34-6
references.pmid: 16280717
references.citation: Clin Orthop Relat Res. 1989 Nov;(248):219-26
references.pmid: 2805484
references.citation: Eur Radiol. 2002 Sep;12(9):2306-12
references.pmid: 12195486
references.citation: J Pediatr Orthop B. 1995;4(1):65-70
references.pmid: 7719837
references.citation: J Pediatr Orthop. 2008 Jan-Feb;28(1):53-9
references.pmid: 18157047
references.citation: Int Orthop. 1997;21(2):137-41
references.pmid: 9195271
references.citation: J Pediatr Orthop B. 1995;4(1):55-7
references.pmid: 7719835
references.citation: J Pediatr Orthop B. 2005 Sep;14(5):347-57
references.pmid: 16093946
references.citation: J Pediatr Orthop. 2002 Jul-Aug;22(4):517-21
references.pmid: 12131451
references.citation: Clin Orthop Relat Res. 1978 Sep;(135):107-18
references.pmid: 709918
references.citation: J Clin Ultrasound. 2004 Jun;32(5):235-42
references.pmid: 15124190
references.citation: J Pediatr Orthop B. 1995;4(2):137-41
references.pmid: 7670980
references.citation: Clin Orthop Relat Res. 2009 May;467(5):1263-70
references.pmid: 19130158
references.citation: Int Orthop. 2008 Feb;32(1):75-9
references.pmid: 17115153
references.citation: J Pediatr Orthop B. 2009 Mar;18(2):76-8
references.pmid: 19282787
references.citation: Acta Radiol. 2004 Oct;45(6):622-7
references.pmid: 15587419
references.citation: J Pediatr Orthop B. 2007 Mar;16(2):98-105
references.pmid: 17273035