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[Arterial blood flow in congenital idiopathic clubfoot]
J L Vispo Seara1, J P Arnold, M Lorenz
1Orthopädische Universitätsklinik Würzburg, König-Ludwig-Haus.
Insights
Vascular causes for congenital idiopathic clubfoot (talipes equinovarus) are unlikely, as doppler ultrasound showed normal arterial pulses in most cases. Postnatal casting has minimal impact on vascularity in these clubfeet.
Area of Science:
- Pediatric Orthopedics
- Vascular Surgery
- Medical Imaging
Background:
- Congenital idiopathic clubfoot (talipes equinovarus, TEV) is a common pediatric deformity.
- The etiology of TEV remains debated, with vascular factors previously suggested.
- Non-invasive vascular assessment can provide valuable insights into foot development.
Purpose of the Study:
- To investigate the vascular status of congenital idiopathic clubfeet using Doppler ultrasound.
- To evaluate the potential influence of casting and physiotherapy on foot vascularity.
- To determine the necessity of routine Doppler assessment in idiopathic clubfeet.
Main Methods:
- Doppler ultrasound (8 MHz continuous wave) was used to assess dorsalis pedis (DP), posterior tibial (PT), and peroneal (P) pulses.
- The study included 40 clubfeet (TEV) and 74 normal feet as controls.
- Measurements were taken at rest in children aged 3-72 months.
Main Results:
- DP and PT pulses were present in all investigated TEVs.
- The P pulse was absent in only one TEV case and one control foot.
- Vascularity in clubfeet was largely unaffected by casting and physiotherapy.
Conclusions:
- A vascular etiology for congenital idiopathic clubfoot is unlikely.
- Postnatal casting shows minimal to no influence on the arterial condition of clubfeet.
- Routine Doppler assessment is not necessary for idiopathic clubfeet but is recommended for syndromic cases before surgery.
Abstract:
A doppler ultrasound study investigated vascularity in congenital idiopathic clubfeet (talipes equinovarus, (TEV) pretreated only by casting and physiotherapy. The studies were performed on 40 TEV (27 patients) aged 4-72 months (average 15.1). In 12 unilateral cases of TEV, the opposite normal foot and 74 normal feet of 37 healthy children aged 3-35 months (average 8.7) were used as controls. Dorsalis pedis (DP), posterior tibial (PT), and peroneal (P) pulses were recorded by an unidirectional 8 MHZ continuous wave technique. At rest, DP pulses and PT pulses were present in all investigated TEVs. P pulse was absent in only one case of TEV. In the group of controls DP pulse was absent in one case and P pulse was absent in an other case of normal foot with contralateral TEV. All the other pulses in normal feet were present at physiological location. We propose that a vascular etiology for the origin of congenital idiopathic clubfoot, as reported in literature, is unlikely. The influence of postnatal casting in TEV on the vascular arterial condition is slight or even absent. Doppler assessment is readily available, noninvasive, and a reproducible mean of monitoring vascular integrity in clubfeet. Relating to vascular complications after surgery, perhaps caused by a preextant arterial anomaly, doppler assessment is indicated routinely in syndromes of multiple malformations with clubfoot deformity before surgical treatment. In congenital idiopathic clubfeet it is not necessary as a routine check.