Can Radiographs Predict Outcome in Patients With Idiopathic Clubfeet Treated With the Ponseti Method?
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Conor P O'Halloran1, Matthew A Halanski, Blaise A Nemeth
1Department of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Insights
Pre-treatment foot dorsiflexion in radiographs predicts recurrence in idiopathic clubfoot treated with the Ponseti method. Achieving 15 degrees of dorsiflexion before tenotomy indicates successful treatment outcomes.
Area of Science:
- Pediatric Orthopedics
- Foot and Ankle Surgery
- Idiopathic Clubfoot Treatment
Background:
- Idiopathic clubfoot is a common congenital condition in children.
- The Ponseti method is a widely used conservative treatment for idiopathic clubfoot.
- Predicting treatment outcomes is crucial for managing idiopathic clubfoot.
Purpose of the Study:
- To evaluate if pre-tenotomy radiographic measurements can predict treatment outcomes in children with idiopathic clubfoot.
- To determine the predictive value of specific radiographic angles for recurrence after Ponseti method treatment.
Main Methods:
- Retrospective review of 71 idiopathic clubfoot cases treated with the Ponseti method over 10 years.
- Analysis of pre-tenotomy lateral foot radiographs measuring foot dorsiflexion, tibio-calcaneal, talo-calcaneal, and talo-first metatarsal angles.
- Correlation of radiographic measurements with clinical outcomes including recurrence and need for further surgery.
Main Results:
- Reduced pre-tenotomy foot dorsiflexion was significantly associated with an increased risk of recurrence (P=0.007).
- An optimal cutoff of 16.6 degrees of dorsiflexion was identified; feet with less dorsiflexion had a higher recurrence rate.
- Only pre-tenotomy foot dorsiflexion independently predicted recurrence (hazard ratio=0.96, P=0.03).
Conclusions:
- Pre-operative radiographic foot dorsiflexion is a key predictor of recurrence in idiopathic clubfoot treated with the Ponseti method.
- Achieving at least 15 degrees of radiographic dorsiflexion before tenotomy suggests a successful treatment trajectory.
- This finding aids in patient selection and outcome prediction for Ponseti method interventions.
Background:
The aim of this study was to determine if radiographic measurements, taken before tenotomy, can predict outcome in children with idiopathic clubfoot treated by the Ponseti method.
Methods:
A retrospective chart and radiographic review was performed on children with idiopathic clubfoot treated with the Ponseti method over a 10-year period with minimum 2-year follow-up that had a forced dorsiflexion lateral foot radiograph before tenotomy. All angles were measured in duplicate on the pretenotomy radiographs, including: foot dorsiflexion (defined as the 90 minus the angle between the tibial shaft and a plastic plate used to dorsiflex the foot), tibio-calcaneal, talo-calcaneal, and talo-first metatarsal angles. Clinical review of patient records identified different patient outcomes: no additional treatment required, relapse (additional casting and/or surgery required), recurrence (any additional surgery required), or reconstruction (surgery not including repeat tenotomy).
Results:
Forty-five patients (71 feet) were included in the study. The median age at follow-up was 4.6 years. The intrareader reliability was acceptable for all measures. Thirteen of the 71 (18%) feet required additional surgery, occurring at a median age of 3.6 years. Of the 4 radiographic measures, only pretenotomy foot dorsiflexion predicted recurrence (hazard ratio=0.96, P=0.03). Youden's method identified 16.6 degrees of dorsiflexion as the optimal cutoff. Feet with at least that amount of dorsiflexion pretenotomy (n=21) experienced no recurrences; feet with less than that amount of dorsiflexion (n=50) experienced 13 recurrences (P=0.007).
Conclusions:
Reduced foot dorsiflexion on lateral forced dorsiflexion pretenotomy radiograph was associated with an increased risk of recurrence. Radiographic dorsiflexion to 15 degrees past neutral before tenotomy appears to predict successful treatment via the Ponseti method.
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