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Ultrasound measurements in clubfoot treated with the Ponseti method and risk factors for recurrence: A retrospective
Imad S Nahle1, Marie-Claude Miron2,3, Guy Grimard2,3
1Clemenceau Medical Center, Affiliated with Johns Hopkins International, Beirut, Lebanon.
Insights
Ultrasound measurements, specifically the distal tibial physis to proximal calcaneal apophysis distance (Ti-C), can predict clubfoot recurrence after Ponseti treatment. Non-compliance with bracing and omitting Achilles tenotomy also increase relapse risk.
Area of Science:
- Pediatric Orthopedics
- Medical Imaging
- Clinical Prognostics
Background:
- Clubfoot recurrence remains a significant challenge in treatment.
- The Ponseti method is a common treatment for idiopathic clubfoot.
- Identifying factors predicting recurrence is crucial for effective management.
Purpose of the Study:
- To determine if ultrasound measurements predict clubfoot recurrence post-Ponseti treatment.
- To identify other factors associated with clubfoot relapse.
- To improve risk stratification for patients undergoing Ponseti method.
Main Methods:
- Seventy-six infants (114 clubfeet) treated with the Ponseti method were reviewed.
- Ultrasound measurements (MTa-N, MM-N, Ta-C, Ti-C) were taken at baseline.
- Recurrence was assessed at a mean 5-year follow-up, with logistic regression analyzing predictors.
Main Results:
- The recurrence rate was 22%.
- The distal tibial physis to proximal calcaneal apophysis distance (Ti-C) was the only ultrasound measure significantly predicting recurrence (p=0.026).
- Non-compliance with orthosis (OR=139.0) and omitting Achilles tenotomy (OR=23.9) were strong predictors of relapse.
Conclusions:
- The Ti-C ultrasound measurement at treatment initiation can identify patients at high risk for clubfoot recurrence.
- Non-compliance with bracing and not performing percutaneous Achilles tenotomy are significant predictive factors for relapse.
- These findings aid in personalized clubfoot management strategies.
Background:
Recurrence remains the main challenge in the treatment of clubfoot. The primary goal of this study is to determine if ultrasound measurements are associated with recurrence after successful management with the Ponseti method. Furthermore, other factors are identified which can be associated with recurrence of the deformity.
Methods:
Seventy-six infants (114 idiopathic clubfeet), all treated with the Ponseti technique were reviewed. All patients had an ultrasound evaluation by the same radiologist at the beginning of the treatment. Recurrence, defined as the need to return to Ponseti casting, was recorded at a mean follow-up of 5 years. Measurements of association with recurrence were obtained for the following ultrasound measures: the medial talonavicular displacement (MTa-N), the medial malleolus to navicular distance (MM-N), the talocalcaneal angle (Ta-C), and the distal tibial physis to proximal calcaneal apophysis distance (Ti-C). Subsequently, a multivariate logistic regression analysis modeling recurrence examined patients' characteristics, compliance, Achilles tenotomy, and ultrasound measurements.
Results:
Recurrence rate was 22% noted in 17 patients. On univariate analysis, relapse was associated with increased MTa-N (p = 0.038), decreased MM-N (p = 0.008), and decreased Ti-C (p = 0.023). On multivariate analysis, we identified the Ti-C as the only ultrasound measurement significantly associated with recurrence (p = 0.026). Other significant predictors for relapse in this study were noncompliance with orthosis (OR = 139.0 (95% CI: 8.7-2224.0), p < 10-3), and omitting percutaneous Achilles tenotomy in clubfoot treatment (OR = 23.9 (95% CI: 1.2-493.6), p = 0.041).
Conclusion:
The Ti-C sonographic measurement at the start of treatment can be a useful adjunct to help identify high-risk patients for recurrence of deformity. Non-compliance with bracing and omitting percutaneous Achilles tenotomy are also predictive factors.
Level Of Evidence:
Prognostic study, Level III.
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