Evaluation of the lateral talocalcaneal angle and lateral tibiocalcaneal angle after using the Ponseti method for congenital clubfoot
LIU Zhen-jiang
YAN Wei
ZHANG Li-jun
LI Qi-wei
Abstract：Objective To investigate the changes of the lateral talocalcaneal angle ( LTCA ) and the lateral tibiocalcaneal angle ( LTiCA ) seen on lateral radiographs taken in the standing position of the patients undergoing treatment for congenital talipes equinovarus by the Ponseti method ( serial manipulation, casting, tenotomy of the Achilles tendon and a foot abduction brace ). Methods From January 2013 to December 2015, 24 patients with congenital talipes equinovarus were treated by the Ponseti method in our department, whose clinical data were retrospectively analyzed. The lateral radiographs of bilateral feet were taken in the standing position of all the patients at the latest follow-up. The Ponseti manipulations, series of castings and percutaneous Achilles tenotomies ( PAT ) were performed by the same pediatric orthopedic surgeon. Clinical assessment indicators included age at the time of initial treatment, sex, unilateral clubfoot or bilateral clubfeet involvement, and numbers of castings as well as PAT determined by the Pirani severity score system before treatment and at the latest follow-up. Radiographic indicators included LTCA, LTiCA and the ratios of the long axis of the talus, which were calculated by measuring the talus long axis of the clubfoot and then dividing this by the talus long axis of the normal foot. For the patients with a unilateral clubfoot, the normal side was used as the control. For the patients with bilateral clubfeet, normal children were chosen to be the control group. The Medical Ethics Committee of Shengjing Hospital of China Medical University approved this study, and informed consents were obtained from all the patients as well as from the children of the needed control group. Results A total of 24 patients ( 32 feet ), 19 males and 5 females, were included in the study. Four patients presented with a left clubfoot, 12 patients with a right clubfoot and 8 patients with bilateral clubfeet. Five normal children ( 10 feet ) were chosen to be the control group for the patients with bilateral clubfeet. The mean number of castings were 5.8 times ( range: 4 - 12 times ). PAT were performed on all 32 clubfeet, and the immobilization time with casting was 3 weeks. In the patients with a unilateral clubfoot, the age at the time of initial treatment varied from 3 to 94 days. The average time of follow-up was 14.75 months ( range: 6 - 35 months ). The Pirani severity scores were compared between pre-treatment and in the latest follow-up: 6.0 versus 0 points ( P50 ), 5.25 versus 0 points ( P25 ) and 6.0 versus 0.375 points ( P75 ), P = 0.000. The average LTCA of the affected feet was 27.81° ( range: 14° - 40° ), and the average LTCA of the normal feet was 51.25° ( range: 38° - 66° ), P = 0.000. The average LTiCA of the affected feet was 82.19° ( range: 51° - 102° ), and the average LTiCA of the normal feet was 79.00° ( range: 57° - 89° ), P = 0.35. The ratio of the long axis of the talus was 81.94% ( range: 71.97% - 96.70% ). In the patients with bilateral clubfeet, the age at the time of initial treatment varied from 8 to 173 days. The average time of follow-up was 21.63 months ( range:3 - 71 months ). The Pirani severity scores recorded between pre-treatment and in the latest follow-up in the left foot of this group were 6.0 versus 0 points ( P50 ), 4.75 versus 0 points ( P25 ), and 6.0 versus 0 points ( P75 ), P = 0.000; the Pirani severity scores recorded between pre-treatment and in the latest follow-up in the right foot of this group were 6.0 versus 0 points ( P50 ), 5.63 versus 0 points ( P25 ), and 6.0 versus 0.375 points ( P75 ), P = 0.000. The average LTCA of the left foot in the bilateral clubfeet patient group was 30.38° ( range: 19° - 46° ), and the average LTCA of the normal left foot in the control group was 53.40° ( range: 46° - 66° ), P = 0.001. The average LTCA of the right foot in the bilateral clubfeet patient group was 33.75° ( range: 20° - 53° ), and the average LTCA of the normal right foot in the control group was 57° ( range: 45° - 70° ), P = 0.001. The average LTiCA of the affected left foot in the bilateral clubfeet patient group was 83.75° ( range: 50° - 111° ), and the average LTiCA of the normal left foot in the control group was 76.60° ( range: 65° - 86° ), P = 0.456. The average LTiCA of the affected right foot in the bilateral clubfeet patient group was 80.75° ( range: 60° - 97° ), and the normal right foot of the control group was 76.80° ( range:69° - 88° ), P = 0.588. Conclusions The Pirani severity scores are significantly improved for the congenital talipes equinovarus treated by the Ponseti method, as well as the foot appearance. The dimensions of the affected talus are reduced. The LTCA is smaller than normal value and the LTiCA is closed to the normal value on the standing lateral radiographs of the feet after the treatment with the Ponseti method.
Keywords：EquinovarusFoot deformitiescongenitalLateral talocalcaneal angle ( LTCA )Lateral tibiocalcaneal angle ( LTiCA )Ponseti method
Publication Date：2017-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 615-620 )