Vascular abnormalities correlate with decreased soft tissue volumes in idiopathic clubfoot.
BACKGROUND
Lower extremity vascular anomalies have been described for patients with clubfoot but few imaging studies have investigated effects on soft tissues such as fat and muscle. To make these assessments we need noninvasive, noncontrast agents to more safely image children.


OBJECTIVE
We describe a novel noninvasive imaging protocol to identify vascular and soft tissue abnormalities in the lower limbs of patients with clubfoot and determine whether these abnormalities are present in patients who had recurrent clubfoot.


METHODS
Three-dimensional noncontrast-enhanced MR angiography was used to identify vascular, bone, and soft tissue abnormalities in patients with clubfoot. We determined whether these abnormalities were more common in patients who had experienced recurrent clubfoot.


RESULTS
Four patients with isolated unilateral clubfoot had arterial anomalies in the clubfoot limb. All patients had less muscle volume in the affected limb, and nine of 11 patients (82%) had less subcutaneous fat, with a mean difference of 0.56 cm(3) ± 0.36 cm(3) (range, 0.08-1.12 cm(3)). Vascular anomalies and decreased fat and muscle volumes were present in all three patients with recurrent clubfoot.


CONCLUSIONS
We found a high frequency of vascular and soft tissue anomalies in the affected limbs of patients with unilateral clubfoot that may correlate with response to treatment.
Department of Orthopedic Surgery, Washington University School of Medicine, 1 Children's Place, Suite 4S60, St Louis, MO 63110, USA.
Laura J
LJ
Merrill
Christina A
CA
Gurnett
Marilyn
M
Siegel
Sushil
S
Sonavane
Matthew B
MB
Dobbs
D000328:Adult; D002648:Child; D003025:Clubfoot / Q000150:complications / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D035002:Lower Extremity / Q000098:blood supply*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D008923:Missouri; D018482:Muscle, Skeletal / Q000002:abnormalities / Q000473:pathology*; D019637:Orthopedic Procedures; D012008:Recurrence; D050151:Subcutaneous Fat / Q000002:abnormalities / Q000473:pathology*; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000150:complications / Q000473:pathology*