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Residual equinus deformity in clubfeet treated with the Ponseti method may be linked to altered talar morphology. Specifically, a decreased talar neck depth and obtuse talar neck angle were observed in affected feet, potentially causing impingement.

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Area of Science:

  • Orthopedic surgery
  • Pediatric orthopedics
  • Foot and ankle anatomy

Background:

  • Residual equinus deformity affects up to 20% of clubfeet treated with the Ponseti method.
  • Persistent equinus despite posterior release may indicate joint incongruity.
  • Understanding ankle morphology differences is crucial for treating residual clubfoot deformities.

Purpose of the Study:

  • To characterize ankle morphology differences in toddlers with residual equinus after Ponseti method treatment.
  • To investigate potential causes of persistent intraoperative equinus.
  • To identify morphological factors contributing to residual equinus deformity in clubfeet.

Main Methods:

  • Comparison of preoperative MRI data from 10 patients (17 feet) with persistent equinus to 16 age-matched controls.
  • Generation of 3D models from MRI data using reverse engineering software.
  • Measurement of talus dimensions (neck depth, neck angle, width, length), volume, and arc of curvature.

Main Results:

  • Clubfeet exhibited significantly less talus volume, width, and length compared to control feet.
  • A decreased talar neck depth was found in clubfeet (2.3 mm) versus controls (3.5-3.6 mm) (P<0.003).
  • An obtuse talar neck angle was observed in clubfeet (153.7°) compared to controls (140.4°) (P=0.01).

Conclusions:

  • Clubfeet treated with the Ponseti method show decreased talar neck depth and an obtuse talar neck angle.
  • These morphological changes may lead to anterior ankle impingement, causing residual equinus.
  • Surgeons should consider these findings when expected dorsiflexion is not achieved after posterior release.