Journal of Foot and Ankle Surgery (Asia Pacific)

Register      Login

VOLUME 5 , ISSUE 1 ( June, 2018 ) > List of Articles

REVIEW ARTICLE

Role of Ultrasonography as a Prognostic Tool for the Treatment of Idiopathic Clubfoot by Ponseti Technique: A Systematic Review of Literature

Prasoon Kumar, Aman Hooda

Keywords : Clubfoot, Ponseti, Prognosis, Talonavicular, Ultrasonography

Citation Information : Kumar P, Hooda A. Role of Ultrasonography as a Prognostic Tool for the Treatment of Idiopathic Clubfoot by Ponseti Technique: A Systematic Review of Literature. J Foot Ankle Surg Asia-Pacific 2018; 5 (1):35-38.

DOI: 10.5005/jp-journals-10040-1086

License: CC BY-NC 4.0

Published Online: 01-03-2017

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Introduction: Modern nonoperative treatment of idiopathic clubfoot consists of the Ponseti technique of manipulation and serial casting. Most patients have an excellent long-term outcomes with minimal pain or disability; however, some patients fail to respond or relapse after initial correction. The challenge is to identify such probable resistant or failed cases, and the factors that determine the same. Ultrasonography (USG) is being explored for the diagnosis and follow-up of clubfoot cases. Research question: Does USG help in prognosticating the effectiveness of Ponseti method in clubfoot correction? Materials and methods: Based on a PubMed search, articles related to usage of USG as a tool to prognosticate the Ponseti method were evaluated over a period of last 10 years. Five studies were identified and assessed. Based on this evaluation, parameters were extracted that could reliably indicate the prognosis. Conclusion: Ultrasonography seems to be a cheap and effective tool to identify and calculate factors like tarsal dysplasia, talonavicular (TN) angle, talocuneiform angle (TCu), and the medial malleolus navicular distance (MMND) that could be evaluated before starting treatment and serially during its course. A low MMND and TN angle or a dysplastic talus indicates stiffness and poor prognosis. A serial increase in MMND and TN angle indicates adequate maintenance of correction. So, these parameters measured by USG could be used to prognosticate the effectiveness of the Ponseti method.


PDF Share
  1. Wynne-Davies R. Genetic and environmental factors in the etiology of talipes equinovarus. Clin Orthop Relat Res 1972 May;84:9-13.
  2. Bridgens J, Kiely N. Current management of clubfoot (congenital talipes equinovarus). BMJ 2010 Feb;340:c355.
  3. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am 1995 Oct;77(10):1477-1489.
  4. Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am 2004 Jan;86-A(1):22-27.
  5. Carroll NC, McMurtry R, Leete SF. The pathoanatomy of congenital clubfoot. Orthop Clin North Am 1978 Jan;9(1): 225-232.
  6. Ippolito E. Update on pathologic anatomy of clubfoot. J Pediatr Orthop B 1995;4(1):17-24.
  7. Byron-Scott R, Sharpe P, Hasler C, Cundy P, Hirte C, Chan A, Scott H, Baghurst P, Haan E. A South Australian populationbased study of congenital talipes equinovarus. Paediatr Perinatal Epidemiol 2005 May;19(3):227-237.
  8. Abdelgawad AA, Lehman WB, van Bosse HJ, Scher DM, Sala DA. Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up. J Pediatr Orthop B 2007 Mar;16(2):98-105.
  9. Lin J, Fessell DP, Jacobson JA, Weadock WJ, Hayes CW. An illustrated tutorial of musculoskeletal sonography: part I, introduction and general principles. AJR Am J Roentgenol 2000 Sep;175(3):637-645.
  10. Tolat V, Boothroyd A, Carty H, Klenerman L. Ultrasound: a helpful guide in the treatment of congenital talipes equinovarus. J Pediatr Orthop B 1995 Feb;4(1):65-70.
  11. Chandrakanth U, Sudesh P, Gopinathan N, Prakash M, Goni VG. 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. J Pediatr Orthop 2016 Oct-Nov;36(7):725-729.
  12. Gupta N, Sudesh P, Prakash M, Tripathy SK, Dhillon MS. Is sonographic calculation of Talonavicular angle during Ponseti correction of clubfoot a reliable prognostic indicator? J Postgrad Med Edu Res 2012 Apr;46(4):190-195.
  13. Mootha AK, Saini R, Krishnan V, Bali K, Kumar V, Dhillon MS. Management of idiopathic clubfoot by the Ponseti technique: our experience at a tertiary referral centre. J Orthop Sci 2011 Mar;16(2):184-189.
  14. Desai S, Aroojis A, Mehta R. Ultrasound evaluation of clubfoot correction during Ponseti treatment: a preliminary report. J Pediatr Orthop 2008 Jan-Feb;28(1):53-59.
  15. El-Adwar KL, Taha Kotb H. The role of ultrasound in clubfoot treatment: correlation with the Pirani score and assessment of the Ponseti method. Clin Orthop Relat Res 2010 Sep;468(9):2495-2506.
  16. Miron MC, Grimard G. Ultrasound evaluation of foot deformities in infants. Pediatr Radiol 2016 Feb;46(2):193-209; quiz 190-192.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.