GN Raj, P Sudesh, V G Goni, Venkat (Chandigarh, India)
The importance in search for a predictive prognostic factor in children affected with clubfoot is important as the results of management either conservative or surgical is not always satisfactory. Though the diagnosis of congenital talipes equino varus is obvious by clinical examination itself, radiographs and other imaging modalities like ultrasonogram are tested repeatedly to ascertain the severity and to predict the prognosis of treatment. There are many classification schemes, but none offers adequate prognostic value. No parameter has been described to accurately define the severity of the deformity. In an attempt to define parameter that correlates with the severity of the deformity as well predict the prognosis of the outcome of any method of treatment; an attempt has been done to measure the anatomical angles on CT scan of the affected feet defining the morphology of deformed talus as well as the interrelation between the tarsal bones. We studied on 20 children with 29 clubfeet,with a mean age group of 7.9 years. All cases had receivedmanipulative casting and soft tissue release before 2 years age and had relapse by the time of presentation.Severity was clinically assessed by ICFSG scoring and 3 of them had GOOD, 17 had FAIR and 9 had POOR outcome scoring. This was correlated with angles measured on CT 3Dreconstructions of the feet, Torsion of talar head, talar neck-body angle (medial inclination and plantar inclination) and talocalcaneal angles in AP and lateral 3D images.
Significant correlation was found with Talar torsion with a p value of 0.007, talocalcaneal angle AP with P value OF 0.008, talocalcaneal angle lateral with p value of 0.03, medial inclination of head of talus with p value of 0.001. Plantar inclination of head of talus is insignificantly related with p value at>0.05
An attempt was made to measure the three dimensional characteristics of talus using a 3D CT Scan and to correlate it with severity of the relapsed deformity. The talar torsion angle correlated significantly with the deformity and we suggest that these parameters can be better predictors of outcome and needs to be studied further in detail.