title: Tarsal Bone Dysplasia in Clubfoot as Measured by Ultrasonography: Can It be Used as a Prognostic Indicator in Congenital Idiopathic Clubfoot? A Prospective Observational Study.
abstract: BACKGROUND
  Congenital talipes equinovarus (CTEV )/clubfoot is the most common congenital orthopedic condition. The success rate of Ponseti casting in the hands of the legend himself is not 100%. The prediction of difficult to correct foot and recurrences still remains a mystery to be solved. We all know that tarsal bones are dysplastic in clubfoot and considering it; we hypothesize that the amount of tarsal dysplasia can predict management duration and outcome. In literature we were not able to find studies that satisfactorily quantify the amount of tarsal dysplasia. Hence, it was considered worthwhile to quantify the amount of dysplasia in tarsal bone and to correlate these parameters with the duration and outcome of treatment by conventional method.
  
  
  METHODS
  A total of 25 infants with unilateral idiopathic clubfoot that have not taken any previous treatment were included in the study. An initial ultrasonography was done before start of treatment in 3 standard planes to measure the maximum length of 3 tarsal bones (talus, calcaneus, and navicular). Ponseti method of treatment was used; pirani scoring was done at each OPD (out patient department) visit. Number of casts required for complete correction and need for any surgical intervention were taken as the outcome parameters.
  
  
  RESULTS
  We found that there is a significant correlation between number of casts required and the dysplasia of talus (α error=0.05). We also found a significant negative correlation between relative dysplasia of talus and number of casts required (r=-0.629 sig=0.001, r=-0.552 sig=0.004).
  
  
  CONCLUSIONS
  Tarsal bone dysplasia as quantified by using ultrasonography can be used as a prognostic indicator in congenital idiopathic clubfoot. Although promising the method needs further studies and can be more useful after long-term follow-up where recurrences if any can be documented.
  
  
  METHODS
  Level II.
authors.affiliation: *Department of Orthopaedics †Department of Radiology, PGIMER, Chandigarh, India.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Chandrakanth
authors.forename: Pebam
authors.initials: P
authors.lastname: Sudesh
authors.forename: NirmalRaj
authors.initials: N
authors.lastname: Gopinathan
authors.forename: Mahesh
authors.initials: M
authors.lastname: Prakash
authors.forename: Vijay G
authors.initials: VG
authors.lastname: Goni
mesh_terms: D001848:Bone Diseases, Developmental / Q000175:diagnosis / Q000601:surgery; D002370:Casts, Surgical; D003025:Clubfoot / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D013165:Splints; D013639:Tarsal Bones / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods