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Dynamic US study in the evaluation of infants with vertical or oblique talus deformities
Nucharin Supakul1, Randall T Loder, Boaz Karmazyn
1Department of Radiology, Indiana University and Riley Hospital for Children, 705 Barnhill Drive, Rm. 1053, Indianapolis, IN 46260, USA. tsupakul@iupui.edu
Insights
Dynamic ultrasound reliably differentiates congenital vertical talus (CVT) from oblique talus (OT) in infants. This imaging technique aids in accurate diagnosis of these complex foot deformities.
Area of Science:
- Pediatric Orthopedics
- Medical Imaging
- Foot Deformities
Background:
- Congenital vertical talus (CVT) and oblique talus (OT) are rare foot deformities.
- Distinguishing between CVT and OT can be challenging using physical examination and radiography.
Purpose of the Study:
- To evaluate the effectiveness of ultrasound (US) in diagnosing CVT and OT.
- To summarize clinical experience with US for these conditions.
Main Methods:
- Dynamic focused ultrasound of the foot was used in children under 6 months with clinically equivocal CVT.
- Diagnostic criteria included persistent talonavicular dislocation on plantar flexion for CVT and its reduction for OT.
- Medical and imaging records were reviewed for diagnosis, underlying conditions, treatment, and outcomes.
Main Results:
- Ultrasound evaluated 13 feet in 10 patients (mean age 33 days).
- Radiographs were non-diagnostic in the two children who had them.
- Ultrasound diagnosis was confirmed by surgery in 7 children with CVT and supported by treatment response in 3 children with OT.
Conclusions:
- Dynamic ultrasound is a reliable method for differentiating CVT and OT.
- Ultrasound provides accurate diagnosis in cases where radiography is inconclusive.
Background:
Congenital vertical talus (CVT) is a rare foot deformity that is sometimes difficult to differentiate from oblique talus (OT) by physical examination and foot radiography.
Objective:
The purpose of this study was to summarize our experience with US in evaluation of CVT and OT deformities.
Materials And Methods:
We identified all children (2005-2011) younger than 6 months who underwent dynamic focused US of the foot at our tertiary-care facility to evaluate clinically equivocal cases of CVT. Diagnostic criteria for CVT were persistent talonavicular dislocation on forced plantar flexion of the foot. OT was diagnosed based on reduction of the talonavicular dislocation on forced plantar flexion. Medical and imaging charts were reviewed for diagnosis on US and plain radiographs (when available) and for underlying neuromuscular disorders, treatment and outcome on follow-up.
Results:
Ten patients (eight boys and two girls, mean age 33 days) were evaluated by US for CVT. Radiographs of the foot were obtained in only two children and were non-diagnostic. Thirteen feet were evaluated by US. Diagnosis of CVT was confirmed by surgery in seven children, three of whom had bilateral CVT. Diagnosis of OT in three children was supported by response to casting treatment.
Conclusion:
Dynamic US can reliably distinguish between CVT and OT deformities.
