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Talar Index: A New Radiologic Marker for Clubfoot Equinus

Varun Garg1, Anil Agarwal2, Sunny Bhalla3

  • 1Department of Orthopedics, AIIMS, Guwahati.

Journal of Pediatric Orthopedics
|March 23, 2026
PubMed

Insights

The Talar Index accurately assesses residual equinus in clubfoot, aiding treatment decisions. This reliable radiologic marker is simple to use in clinical settings.

Area of Science:

  • Orthopedics
  • Pediatric Orthopedics
  • Radiology

Background:

  • Residual equinus is a key indicator for tenotomy and recurrence monitoring in clubfoot deformity.
  • Objective assessment of residual equinus is crucial for effective clubfoot management.

Purpose of the Study:

  • To validate a novel radiologic marker, the Talar Index, for objective assessment of residual equinus in idiopathic clubfoot.
  • To evaluate the diagnostic accuracy and reliability of the Talar Index.

Main Methods:

  • A cross-sectional observational study involving infants with idiopathic clubfoot treated with the Ponseti protocol.
  • The Talar Index was assessed against unaffected feet, with validity tested using Receiver Operating Characteristic (ROC) analysis and logistic regression.
  • Interobserver and intraobserver reliability were evaluated using Cohen's kappa.

Main Results:

  • The Talar Index demonstrated high accuracy in identifying residual equinus (94.3%), with sensitivity of 95.9% and specificity of 90.5%.
  • A strong association was found between a positive Talar Index and increased lateral tibiocalcaneal angle (AUC: 0.929, P=0.001).
  • Excellent interobserver (κ=0.84) and intraobserver (κ=0.97) reliability was achieved.

Conclusions:

  • The Talar Index is a valid, reliable, and easily interpretable radiologic marker for assessing residual equinus in clubfoot.
  • Its simplicity and high diagnostic accuracy support its routine clinical use, even in resource-limited settings.
Abstract

Keywords:
CTEVclubfootlateral tibio-calcaneal angleradiographyresidual equinus

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