Purpose: To elucidate the pathomorphology of the unossified clubfoot and to monitor the progressive correction of the deformity during treatment, the authors introduce a standardized sonographic assessment of the foot at birth and at the end of both conservative and surgical corrective procedures.
Methods: 42 congenital clubfeet and 42 normal newborns were documented by ultrasound using a 7,5/10 MHz linear arrays probe with direct contact. Clubfeet were documented in the position of spontaneous alignment and during passive manual correction at the admission and at the end of both conservative and surgical treatment. Five standard ultrasound planes were used: sagittal posterior, sagittal anterior, coronal lateral, transversal and coronal medial plane.
Results: On the sagittal posterior plane the progressive gain of the dorsiflexion during the different steps of the treatment was documented measuring the distance between the distal tibial metaphysis and the calcaneal apophysis. In clubfeet. looking at the ossification centre of the talus, both its forfeit of domicile in the ankle mortise and its right positioning after treatment can be showed. On the sagittal anterior plane and on the transversal plane the medial displacement of the navicular is documented. The normalisation of the anatomic alignment of the navicular is well documented by these planes after appropriate treatment. On coronal lateral plane the relationships between the os calcis and cuboid can be estimated using the calcaneal-cuboid angle. The coronal medial plane exhibited a very low reproducibility in the neonatal clubfoot and it is not reccomended
Conclusions: Ultrasonography it is a very promising technique in the monitoring of clubfoot deformity during treatment. On the sagittal posterior and on the coronal lateral planes strictly quantitative information can be easily deduced while prevalently qualitative information are deduced on the sagittal anterior and on the transversal planes. Ultrasound gives exact and reproducible information concerning the pathomorphology of the not ossified
Gigante, C., Talenti E., Turra, S.
Servizio di Ortopedia Pediatrica, Azienda Ospedaliera-Universita di Padova, Padova, Italy
Copyright British Editorial Society of Bone & Joint Surgery 2003
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