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What exactly is “foot abduction” during management of idiopathic clubfoot in clinical practice?

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Abstract

Purpose

There is however gross ambiguity regarding the use of term “foot abduction” in clubfoot treatment. We measured below defined angles at different stages of clubfoot treatment to decipher their precise interpretation.

Methods

In a prospective evaluation of 25 unilateral clubfeet in infants’ age less than six months treated with Ponseti technique, clinical leg foot and thigh foot angle were measured at talar head reduction (LHT0), pre-tenotomy, and post-tenotomy stage. A “normal” reference was available in the form of measurements of contralateral limb.

Results

Talar head (LHT0) was reduced at mean leg foot angle of 26 degrees. The corresponding pre- and post-tenotomy angles were 42.6 and 50.0 degrees, respectively. The reference leg foot angles for contralateral limb were 49.8 degrees. The thigh foot angle for LHT0, pre-tenotomy, post-tenotomy, and contralateral side were, respectively, 39.2, 56, 68, and 65.6 degrees. There was an additional tibial external rotation component of mean 13.4 degrees (SD 4.5) in the thigh foot angle when compared to the leg foot angle at tenotomy. This increased to 18 degrees (SD 3.4) post-tenotomy.

Conclusions

The study suggested that the foot abduction described in the “Ponseti Manual” probably intends thigh foot rather than leg foot angles. There was a significant difference in the angles when talar head reduced and tenotomy was decided. The foot abduction is an ambiguous term which should be replaced by the more specific leg or thigh foot abduction angle.

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Data availability

The raw data can be provided on reasonable request to the corresponding author.

References

  1. Shabtai L, Specht SC, Herzenberg JE (2014) Worldwide spread of the Ponseti method for clubfoot. World J Orthop 5:585–590. https://doi.org/10.5312/wjo.v5.i5.585

    Article  PubMed  PubMed Central  Google Scholar 

  2. Elgohary HSA, Abulsaad M (2015) Traditional and accelerated Ponseti technique: a comparative study. Eur J Orthop Surg Traumatol 25:949–953. https://doi.org/10.1007/s00590-015-1594-5

    Article  PubMed  Google Scholar 

  3. Dobbs MB, Rudzki JR, Purcell DB et al (2004) Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am 86:22–27. https://doi.org/10.2106/00004623-200401000-00005

    Article  PubMed  Google Scholar 

  4. Tahririan MA, Ardakani MP, Kheiri S (2021) Can clubfoot scoring systems predict the number of casts and future recurrences in patients undergoing Ponseti method? J Orthop Surg Res 16:238. https://doi.org/10.1186/s13018-021-02261-4

    Article  PubMed  PubMed Central  Google Scholar 

  5. Barik S, Nazeer M, Mani BT (2019) Accelerated Ponseti technique: efficacy in the management of CTEV. Eur J Orthop Surg Traumatol 29:919–924. https://doi.org/10.1007/s00590-018-2353-1

    Article  PubMed  Google Scholar 

  6. Pulak S, Swamy M (2012) Treatment of idiopathic clubfoot by ponseti technique of manipulation and serial plaster casting and its critical evaluation. Ethiop J Health Sci 22:77–84

    PubMed  PubMed Central  Google Scholar 

  7. Pirani S, Staheli L, Naddumba E (2008) Ponseti clubfoot management: teaching manual for healthcare providers in Uganda, 1st edn. GHO Publications, Seattle

  8. Lourenço AF, Morcuende JA (2007) Correction of neglected idiopathic club foot by the Ponseti method. J Bone Joint Surg Br 89-B:378–381 https://doi.org/10.1302/0301-620X.89B3.18313

  9. Mosca V (2008) Clubfoot: biomechanics and practical principles-based application of the Ponseti method, 1st edn. Global HELP Organisation, Seattle

  10. Gupta P, Mittal N, Jindal N et al (2017) A study of normal foot abduction across various age groups in children. Int Orthop 41:2365–2369. https://doi.org/10.1007/s00264-017-3603-2

    Article  PubMed  Google Scholar 

  11. Agarwal A, Rastogi P (2021) Dimeglio’s derotation of calcaneo pedal block and Pirani’s talar head reduction: a quantitative matching. J Pediatr Orthop B 30:467–470. https://doi.org/10.1097/BPB.0000000000000812

    Article  PubMed  Google Scholar 

  12. Dietz FR, Noonan K (2016) Treatment of clubfoot using the Ponseti method. JBJS Essent Surg Tech 6:e28 https://doi.org/10.2106/JBJS.ST.14.00112

  13. Diméglio A, Bensahel H, Souchet P et al (1995) Classification of clubfoot. J Pediatr Orthop B 4:129–136. https://doi.org/10.1097/01202412-199504020-00002

    Article  PubMed  Google Scholar 

  14. Agarwal A, Barik S (2019) Effect of bar length on foot abduction and ankle dorsiflexion in Steenbeek foot abduction brace. J Pediatr Orthop B 28:564–571. https://doi.org/10.1097/BPB.0000000000000652

    Article  PubMed  Google Scholar 

  15. Shah A, Mehta R, Aroojis A (2019) The Ponseti method of clubfoot treatment in walking age children: is it effective? A study of 56 children from 1 to 10 years of age. J Pediatr Orthop B 28:159–166. https://doi.org/10.1097/BPB.0000000000000562

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India

    Yogesh Patel & Anil Agarwal

  2. Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India

    Sitanshu Barik

Authors
  1. Yogesh Patel
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  2. Sitanshu Barik
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  3. Anil Agarwal
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Dr. Yogesh and Dr. Anil Agarwal. The first draft of the manuscript was written by Dr. Sitanshu Barik, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Anil Agarwal.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Ethics Committee of Chacha Nehru Bal Chikitsalaya (F.I/IEC/CNBC/18/01/2022/Protocol no 103/263).

Consent to participate

Written informed consent was obtained from the parents.

Consent to publish

Written informed consent was obtained from the parents.

Competing interests

The authors declare no competing interests.

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Patel, Y., Barik, S. & Agarwal, A. What exactly is “foot abduction” during management of idiopathic clubfoot in clinical practice?. International Orthopaedics (SICOT) 47, 1109–1114 (2023). https://doi.org/10.1007/s00264-023-05703-2

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  • DOI: https://doi.org/10.1007/s00264-023-05703-2

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