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Related Experiment Video

Updated: May 26, 2026

Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus
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Radiographic Assessment and Measurement Reliability in Defining Flat-Top Talus in Ponseti-Treated Clubfeet.

María Galán-Olleros1, Ahmed M Ahmed2, Eleftheria Samara3

  • 1Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.

Journal of Pediatric Orthopedics
|May 25, 2026
PubMed
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Flat-top talus (FTT) deformity in pediatric clubfoot is best identified by qualitative assessment of talar dome morphology, which showed superior reliability over quantitative radiographic measures. Quantitative parameters may help research but need validation for clinical use in children.

Area of Science:

  • Orthopedic surgery
  • Pediatric radiology
  • Foot and ankle deformities

Background:

  • Flat-top talus (FTT) deformity in clubfoot can lead to ankle impingement and degenerative changes.
  • The reliability of quantitative radiographic parameters for defining FTT in children is not well-established.

Purpose of the Study:

  • To compare quantitative radiographic measures for defining FTT.
  • To evaluate the inter- and intrarater reliability of these measures against qualitative assessment of talar dome morphology.

Main Methods:

  • Retrospective dual-center cohort study of 152 Ponseti-treated clubfeet with lateral radiographs.
  • Measured quantitative parameters (talar height, length, radius, ratios, ATMS, ADTA, Meary angle) and performed qualitative assessment.
  • Assessed discrimination using ROC analysis and reliability using ICC and Cohen Kappa.
Keywords:
Ponseti methodclubfootradiographyreproducibility of resultstalus

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Last Updated: May 26, 2026

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Main Results:

  • FTT feet showed greater talar radius, length, R/L ratio, and smaller H/L ratio and ATMS.
  • Radius, R/L ratio, and ATMS best discriminated FTT.
  • Qualitative assessment demonstrated substantial agreement (κ=0.80), superior to quantitative measures like R/L ratio (κ=0.29).

Conclusions:

  • Quantitative parameters for FTT show limited reproducibility in children.
  • Qualitative assessment of talar dome morphology is the most reliable and practical method for defining FTT in pediatric clubfoot.
  • Quantitative measures require pediatric-specific validation for research applications.