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Published on: January 23, 2018
Factors Associated With Flat-Top Talus in Radiographically Evaluated Ponseti-Treated Clubfeet.
María Galán-Olleros1, Eleftheria Samara2, Ahmed M Ahmed3
1Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
Journal of Pediatric Orthopedics
|June 19, 2026
Summary
Flat-top talus (FTT) in clubfoot treated with the Ponseti method is linked to higher initial deformity severity and increased casting. This finding highlights FTT as a marker of treatment burden, not recurrence.
Area of Science:
- Pediatric Orthopedics
- Foot and Ankle Surgery
- Congenital Deformities
Background:
- Flat-top talus (FTT) is a known complication of clubfoot, leading to stiffness and early ankle degeneration.
- The frequency and contributing factors of FTT after Ponseti treatment are not well-defined.
Purpose of the Study:
- To identify clinical and treatment-related factors associated with FTT in clubfeet treated with the Ponseti method.
Main Methods:
- Retrospective dual-center cohort study (2005-2023) of children with clubfoot treated by the Ponseti method.
- Talar morphology assessed qualitatively by blinded raters on lateral radiographs.
- Univariate logistic regression analyzed clinical variables and treatment exposures.
Main Results:
- FTT was identified in 68% of 152 evaluated feet.
- Higher Pirani score at diagnosis and greater cumulative casting exposure (≥13 casts) were associated with increased odds of FTT.
- Prior surgery before imaging also correlated with higher FTT odds.
Conclusions:
- FTT in Ponseti-treated clubfeet is associated with greater baseline deformity, extensive casting, and prior surgery.
- FTT may indicate intrinsic rigidity and treatment burden rather than driving recurrence.
- Identifying these factors aids in monitoring talar morphology and managing patient expectations.
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