The role of ultrasound in clubfoot treatment: correlation with the Pirani score and assessment of the Ponseti method.
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.
El-Adwar
Khaled Loutfy
KL
Hadra Orthopaedic University Hospital, Lambrouso, Alexandria,Egypt. khaled_eladwar@yahoo.com
Taha Kotb
Hesham
H
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
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