Related Experiment Video
Updated: Apr 16, 2026
Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling
Published on: February 5, 2019
Reliability of radiographic measures in infants with clubfoot treated with the Ponseti method
Catherine C Zimmerman1, Blaise A Nemeth, Kenneth J Noonan
1Department of Orthopedics and Rehabilitation, University of Wisconsin, American Family Children's Hospital, 1685 Highland Ave., Suite 6170-11D, Madison, WI, 53705, USA.
Insights
Radiographic measurements are reliable for infants treated with the Ponseti method for clubfoot. This study confirms consistent measurements before and after Achilles tenotomy, aiding treatment assessment.
Area of Science:
- Orthopedics
- Pediatric orthopedics
- Radiology
Background:
- The Ponseti method is a common treatment for congenital clubfoot.
- Accurate radiographic assessment is crucial for monitoring treatment progress.
- Reliability of radiographic measures in infants undergoing this treatment requires validation.
Purpose of the Study:
- To assess the reliability of radiographic measurements in infants treated with the Ponseti method.
- To document radiographic changes in clubfeet before and after Achilles tenotomy.
Main Methods:
- Retrospective review of 36 infants (56 feet) treated with the Ponseti method over 10 years.
- Five independent reviewers performed triplicate measurements of specific angles on pre- and post-Achilles tenotomy lateral forced dorsiflexion radiographs.
- Intra- and inter-reader reliability for dorsiflexion, tibio-calcaneal, talo-calcaneal, and talo-first metatarsal angles were calculated using intra-class correlation coefficients (ICC).
Main Results:
- High intra-reader reliability (ICC 0.864-0.995) and good to excellent inter-reader reliability (ICC 0.727-0.950) were observed.
- Significant radiographic changes were noted post-Achilles tenotomy: mean increases of 17° in dorsiflexion, 19° in tibio-calcaneal angle, 9° in talo-calcaneal angle, and 10° in talo-first metatarsal angle (p ≤ 0.001).
Conclusions:
- Radiographic measurements using lateral dorsiflexion views are reliable in infants undergoing the Ponseti method.
- These reliable measures effectively document the positive radiographic changes following Achilles tenotomy in clubfoot treatment.
Purpose:
The aim of this study was two-fold: (1) to determine if radiographic measures can be reliably made in infants being treated with the Ponseti method and (2) to document radiographic changes before and after Achilles tenotomy.
Methods:
A retrospective radiographic and chart review was performed on children with clubfoot treated by the Ponseti method at a single institution over a 10-year period. Five independent reviewers measured a series of angles from a lateral forced dorsiflexion radiograph taken prior to and following Achilles tenotomy. These measures were taken in triplicate to determine the intra- and inter-reader reliability of dorsiflexion, tibio-calcaneal, talo-calcaneal, and talo-first metatarsal angles.
Results:
Thirty-six subjects (56 feet) were treated with the Ponseti method and met the inclusion criteria. The median (range) age of patients at the time of tenotomy was 52 (34-147) days. The intra-reader reliability [intra-rater correlation coefficient (ICC)] for each of the measured angles pre- and post-tenotomy ranged from 0.933 to 0.995 and 0.864 to 0.995, respectively. Similarly, the inter-reader reliabilities (ICC) ranged from 0.727 for the pre-tenotomy (talo-calcaneal) to 0.950 for the post-tenotomy (talo-first metatarsal) angles. The mean differences between pre- and post-tenotomy radiographs were: dorsiflexion increase of 17°, tibio-calcaneal angle increase of 19°, talo-calcaneal angle increase of 9°, and talo-first metatarsal angle increase of 10° (p-value ≤0.001 for all measurements except the talo-first metatarsal angle, with a p-value of 0.001).
Conclusions:
Reliable radiographic measures can be made from lateral dorsiflexion radiographs of clubfeet treated with the Ponseti method before and after Achilles tenotomy.
More Related Videos
09:01Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
06:28Anterior Cruciate Ligament Transection and Synovial Fluid Lavage in a Rodent Model to Study Joint Inflammation and Posttraumatic Osteoarthritis
Published on: September 2, 2025