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Neonatal foot deformities and their relationship to developmental dysplasia of the hip: an 11-year prospective,
1Department of Orthopaedics, Royal Blackburn Hospital, Haslingden Road, Blackburn, UK.
Insights
Neonatal foot deformities like postural talipes equinovarus and congenital talipes equinovarus do not require routine hip screening. However, infants with congenital talipes calcaneovalgus and metatarsus adductus warrant continued hip surveillance.
Area of Science:
- Pediatric Orthopedics
- Neonatal Care
- Diagnostic Imaging
Background:
- Neonatal foot deformities are common and may be associated with developmental dysplasia of the hip (DDH).
- Previous recommendations suggested routine screening for DDH in infants with foot deformities.
- The diagnostic criteria for some foot deformities, like postural talipes equinovarus, are not well-defined.
Purpose of the Study:
- To assess the relationship between specific neonatal foot deformities and the presence of ultrasonographic developmental dysplasia of the hip (DDH).
- To determine the risk of hip instability or dislocation in infants with different types of foot deformities.
- To refine screening guidelines for DDH in neonates with foot deformities.
Main Methods:
- Prospective study conducted over 11 years (1996-2006).
- Inclusion of 614 infants with foot deformities referred for clinical and ultrasonographic evaluation.
- Categorization of foot deformities into postural talipes equinovarus (TEV), fixed congenital talipes equinovarus (CTEV), congenital talipes calcaneovalgus (CTCV), and metatarsus adductus.
Main Results:
- The risk of ultrasonographic hip dysplasia or instability varied significantly across foot deformity types.
- Congenital talipes calcaneovalgus (CTCV) showed a higher risk (1:5.2) for hip dysplasia/instability compared to postural TEV (1:27) and metatarsus adductus (1:25).
- Fixed congenital talipes equinovarus (CTEV) had a notable risk (1:8.6) for hip dysplasia/instability, but no cases of type IV hip instability or irreducible dislocation were observed in this group.
Conclusions:
- Routine DDH screening is no longer recommended for infants with postural talipes equinovarus (TEV) due to poor definition and potential over-diagnosis.
- Continued ultrasonographic imaging and surveillance of the hips are advised for infants diagnosed with congenital talipes calcaneovalgus (CTCV).
- Infants with metatarsus adductus may also benefit from continued hip surveillance, though the risk appears lower than in CTCV.
Abstract:
In a prospective study over 11 years we assessed the relationship between neonatal deformities of the foot and the presence of ultrasonographic developmental dysplasia of the hip (DDH). Between 1 January 1996 and 31 December 2006, 614 infants with deformities of the foot were referred for clinical and ultrasonographic evaluation. There were 436 cases of postural talipes equinovarus deformity (TEV), 60 of fixed congenital talipes equinovarus (CTEV), 93 of congenital talipes calcaneovalgus (CTCV) and 25 of metatarsus adductus. The overall risk of ultrasonographic dysplasia or instability was 1:27 in postural TEV, 1:8.6 in CTEV, 1:5.2 in CTCV and 1:25 in metatarsus adductus. The risk of type-IV instability of the hip or irreducible dislocation was 1:436 (0.2%) in postural TEV, 1:15.4 (6.5%) in CTCV and 1:25 (4%) in metatarsus adductus. There were no cases of hip instability (type IV) or of irreducible dislocation in the CTEV group. Routine screening for DDH in cases of postural TEV and CTEV is no longer advocated. The former is poorly defined, leading to the over-diagnosis of a possibly spurious condition. Ultrasonographic imaging and surveillance of hips in infants with CTCV and possibly those with metatarsus adductus should continue.
