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Published on: June 29, 2013
Efficacy of prenatal ultrasonography in confirmed club foot
1Department of Paediatric Orthopaedics, Dana Children's Hospital, Tel Aviv Medical Centre and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Insights
Prenatal ultrasound can diagnose club foot in over 60% of cases, with diagnosis possible as early as 12 weeks gestation. Accuracy correlates with postnatal findings, but not treatment approach.
Area of Science:
- Medical Imaging
- Prenatal Diagnosis
- Orthopedics
Background:
- Club foot (congenital talipes equinovarus) is a common congenital birth defect.
- Early diagnosis of club foot can aid in timely intervention and management.
- Prenatal ultrasound is a key tool for fetal anomaly screening.
Purpose of the Study:
- To evaluate the accuracy of prenatal ultrasound in diagnosing club foot.
- To correlate prenatal ultrasound findings with postnatal physical examination and treatment.
- To determine the gestational age at which club foot can be reliably detected.
Main Methods:
- Retrospective analysis of 281 prenatal ultrasound surveys.
- Correlation of ultrasound findings with postnatal physical examination in 147 children with club foot.
- Review of subsequent treatment strategies (conservative vs. surgical).
Main Results:
- Club foot was diagnosed prenatally in over 60% of cases.
- Diagnosis was possible with high confidence between 12 and 32 weeks gestation.
- 86% of diagnoses occurred between 12-23 weeks; 14% between 24-32 weeks.
- Bilateral club foot was more common than unilateral.
- No significant relationship found between prenatal diagnosis and postnatal treatment or foot rigidity.
Conclusions:
- Prenatal ultrasound is a valuable tool for detecting club foot, with a significant proportion diagnosed early in gestation.
- While ultrasound can identify club foot, a notable percentage are missed on initial scans.
- Prenatal diagnosis does not appear to influence the choice of treatment or the severity of the condition postnatally.
Abstract:
Club foot can be diagnosed by ultrasound of the fetus in more than 60% of cases. We have correlated the accuracy of the prenatal findings in 281 ultrasound surveys with the physical findings after birth and the subsequent treatment in 147 children who were born with club foot. The earliest week of gestation in which the condition was diagnosed with a high degree of confidence was the 12th and the latest was the 32nd. Not all patients were diagnosed at an early stage. In 29% of fetuses the first ultrasound examination failed to detect the deformity which subsequently became obvious at a later examination. Club foot was diagnosed between 12 and 23 weeks of gestation in 86% of children and between 24 and 32 weeks of gestation in the remaining 14%. Therefore it can be considered to be an early event in gestation (45% identified by the 17th week), a late event (45% detected between 18th and 24th weeks) or a very late event (10% recognised between 25th and 32nd weeks). We cannot exclude, however, the possibility that the late-onset groups may have been diagnosed late because earlier scans were false-negative results. The prenatal ultrasonographic findings were correlated with the physical findings after birth and showed that bilateral involvement was more common than unilateral. There was no significant relationship between the prenatal diagnosis and the postnatal therapeutic approach (i.e., conservative or surgical), or the degree of rigidity of the affected foot.
