Improving Prenatal Diagnosis Precision for Congenital Clubfoot by Using Three-Dimensional Ultrasonography

Area of Science:

• Fetal Medicine
• Orthopedic Surgery
• Medical Imaging

Background:

• Congenital clubfoot diagnosis traditionally uses 2D ultrasonography.
• Predicting postnatal treatment needs remains a challenge.
• 3D ultrasonography offers enhanced visualization for fetal anomalies.

Purpose of the Study:

• To evaluate 3D ultrasonography parameters for differentiating pathological clubfoot.
• To predict postnatal treatment requirements based on prenatal ultrasound findings.
• To compare sonographic variables between treated and non-treated clubfoot cases.

Main Methods:

• Retrospective analysis of 31 pregnancies (47 feet) with suspected clubfoot (2018-2021).
• Utilized 3D ultrasonography to measure hindfoot varus, equinus, calcaneopedal block, and forefoot adduction angles.
• Compared prenatal measurements with postnatal treatment outcomes (serial casting, Achilles tenotomy).

Main Results:

• 37 feet (78.7%) required postnatal treatment.
• Treated feet showed significantly higher hindfoot varus (60.5° vs. 46.6°) and calcaneopedal block (65.6° vs. 26.6°) deviations.
• Calcaneopedal block deviation (threshold 46.2°) demonstrated high diagnostic accuracy (AUC 0.98, sensitivity 97%, specificity 90%).

Conclusions:

• 3D ultrasonography provides detailed prenatal assessment of clubfoot.
• The calcaneopedal block angle is a strong predictor of postnatal treatment necessity.
• This imaging technique can guide clinical management and parental counseling for congenital clubfoot.