Department of Orthopaedic Surgery and Traumatology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.
Department of Orthopaedic Surgery and Traumatology, Qena Faculty of Medicine, South Valley University, Kilo 6 Qena-Safaga highway, Qena, Egypt.
Int Orthop. 2021 Dec;45(12):3139-3146. doi: 10.1007/s00264-021-05138-7. Epub 2021 Jul 27.
Idiopathic congenital talipes equinovarus is the most commonly encountered congenital deformity of the foot. Ponseti technique of manipulation is the treatment of choice. The Pirani classification is a reliable scoring system for clinical evaluation of clubfeet. The role of radiographic parameters in the evaluation and treatment of clubfeet is still controversial. The aim of this study was to evaluate the correlation of radiological parameters with clinical correction in patients with idiopathic clubfeet undergoing correction using Ponseti method.
Between March 2018 and March 2019, 42 feet in 27 patients with idiopathic clubfeet were treated in our hospital. We used the Pirani scoring system for clinical evaluation. Anteroposterior and lateral views of the feet were taken before and after correction and at the last follow-up. The anteroposterior view was evaluated for the talocalcaneal angle and talo-first metatarsal angle, while the lateral view was only evaluated for the talocalcaneal angle.
Twelve were boys (44.4%), and 15 were girls (55.6%). The deformity was bilateral in 15 patients (55.6%) and unilateral in 12 patients (44.4%). The average age was three months. According to the Pirani score, the mean Pirani Total score was 4.4 before correction and reduced to 0.4 after correction. The mean talocalcaneal angle in anteroposterior and lateral views was 15.1° and 7.8° before correction, increased to 32.7° and 31.8° after correction, respectively. The mean talocalcaneal index increased from 23.2 before correction to 64.5 after correction. The mean talo-first metatarsal angle in anteroposterior view improved from 25.7° before correction to - 1.6° after correction. The relation between the differences in Pirani scores before and after correction and the differences in measured radiographic parameters before and after correction revealed a statistically significant correlation.
Radiographic parameters showed a statistically significant correlation with the clinical outcome. Thus, evaluation of clubfeet correction treated by Ponseti technique can rely mainly on clinical scores with limited utilization of radiological assessment.
特发性先天性马蹄内翻足是最常见的足部先天性畸形。手法 Ponseti 技术是首选的治疗方法。Pirani 分类是一种可靠的临床评估马蹄内翻足的评分系统。放射学参数在评估和治疗马蹄内翻足中的作用仍存在争议。本研究旨在评估特发性马蹄内翻足患者接受 Ponseti 法矫正后放射学参数与临床矫正的相关性。
2018 年 3 月至 2019 年 3 月，我院收治特发性马蹄内翻足患者 27 例，42 足。我们采用 Pirani 评分系统进行临床评估。在矫正前后及末次随访时拍摄足部前后位和侧位片。前后位评估距跟角和跟第一跖骨角，侧位仅评估距跟角。
男 12 例（44.4%），女 15 例（55.6%）。15 例（55.6%）为双侧畸形，12 例（44.4%）为单侧畸形。平均年龄 3 个月。根据 Pirani 评分，矫正前平均 Pirani 总评分 4.4 分，矫正后降至 0.4 分。前后位距跟角和侧位距跟角分别为 15.1°和 7.8°，矫正后分别增加至 32.7°和 31.8°。矫正前距跟角指数为 23.2，矫正后增加至 64.5。前后位跟第一跖骨角由矫正前的 25.7°改善至矫正后的-1.6°。矫正前后 Pirani 评分差值与矫正前后测量放射学参数差值之间存在统计学显著相关性。
放射学参数与临床结果具有统计学显著相关性。因此，对于接受 Ponseti 技术治疗的马蹄内翻足矫正的评估，主要可以依赖临床评分，放射学评估的应用有限。
