Abstract
Foot deformity in infants is the most common congenital musculoskeletal condition. A precise diagnosis can sometimes be impossible to establish clinically. Radiologic imaging plays a major role in the evaluation of musculoskeletal abnormalities. However conventional imaging techniques, such as plain radiographs of the foot, are of very little help in this age group because of the lack of ossification of the tarsal bones. US presents a significant advantage because it permits the visualization of cartilaginous structures. This leads to the detailed assessment of foot deformities in infants. Furthermore, US can also be used as a dynamic imaging modality. Different scanning views are beneficial to evaluate the complete anatomy of the foot; depending on the suspected clinical diagnosis, some planes are more informative to display the pathological features of a specific deformity. We describe the US findings of five of the most common foot deformities referred to our pediatric orthopedic clinic (clubfoot, simple metatarsus adductus, skewfoot, and oblique and vertical talus). For each deformity we propose a specific imaging protocol based on US to provide an accurate diagnosis. US is a complementary tool to the clinical examination for determining the diagnosis and the severity of the deformity and also for monitoring the efficacy of treatment. Radiologists investigating foot deformities in infants should consider using US for the detailed assessment of the foot in this age group.
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References
Morrissy RT, Weinstein SL (2006) Lovell and Winter’s pediatric orthopaedics, 6th edn. Lippincott, Williams & Wilkins, Philadelphia
Herring JA (2008) Tachdjian’s pediatric orthopaedics. From the Texas Scottish Rite Hospital for Children, 4th edn. Saunders Elsevier, Philadelphia
Dobbs MB, Gurnett CA (2009) Update on clubfoot: etiology and treatment. Clin Orthop Relat Res 467:1146–1153
Wynne-Davies R (1964) Family studies and the cause of congenital clubfoot. Talipes equinovarus, talipes calcaneovalgus and metatarsus varus. J Bone Joint Surg (Br) 46:445–463
Dodwell E, Risoe P, Wright J (2013) A prospective determination of environmental factors associated with clubfoot (poster). Pediatric Orthopaedic Society of North America (POSNA) Annual Meeting, Toronto
Diméglio A, Bensahel H, Souchet P et al (1995) Classification of clubfoot. J Pediatr Orthop B 4:129–136
Pirani S, Hodges D, Sekeramayi F (2008) A reliable and valid method of assessing the amount of deformity in the congenital clubfoot deformity. J Bone Joint Surg (Br) 90:53
Aitken JT, Causey G, Joseph J et al (1966) The foot. In: Aitken JT, Causey G, Joseph J, Young JZ (eds) A manual of human anatomy. Vol IV, Lower limb, 2nd edn. E&S Livingstone, Edinburgh
Tolat V, Boothroyd A, Carty H et al (1995) Ultrasound: a helpful guide in the treatment of congenital talipes equinovarus. J Pediatr Orthop B 4:65–70
Maiza D, Themar-Noel C, Legrand I et al (1995) Ultrasonographic approach to the neonatal foot: preliminary study. J Pediatr Orthop B 4:123–128
Hamel J, Becker W (1996) Sonographic assessment of clubfoot deformity in young children. J Pediatr Orthop B 5:279–286
Chami M, Daoud A, Maestro M et al (1996) Ultrasound contribution in the analysis of the newborn and infant normal and clubfoot: a preliminary study. Pediatr Radiol 26:298–302
Hansson G, Aurell Y (2002) Use of ultrasonography prior to surgery for assessment of clubfoot anatomy. J Bone Joint Surg Br 84:112
Aurell Y, Johansson A, Hansson G et al (2002) Ultrasound anatomy in the neonatal clubfoot. Eur Radiol 12:2509–2517
Aurell Y, Johansson A, Hansson G et al (2002) Ultrasound anatomy in the normal neonatal and infant foot: an anatomic introduction to ultrasound assessment of foot deformities. Eur Radiol 12:2306–2312
Kuhns LR, Koujok K, Hall JM et al (2003) Ultrasound of the navicular during the simulated Ponseti maneuver. J Pediatr Orthop 23:243–245
Gigante C, Talenti E, Turra S (2004) Sonographic assessment of clubfoot. J Clin Ultrasound 32:235–242
Suda R, Suda AJ, Grill F (2006) Sonographic classification of idiopathic clubfoot according to severity. J Pediatr Orthop B 15:134–140
Shiels WE 2nd, Coley BD, Kean J et al (2007) Focused dynamic sonographic examination of the congenital clubfoot. Pediatr Radiol 37:1118–1124
Aurell Y, Andriesse H, Johansson A et al (2005) Ultrasound assessment of early clubfoot treatment: a comparison of the Ponseti method and a modified Copenhagen method. J Pediatr Orthop B 14:347–357
Ponseti V (1992) Treatment of congenital clubfoot. J Bone Joint Surg Am 74:448–454
Radler C, Manner HM, Suda R et al (2007) Radiographic evaluation of idiopathic clubfeet undergoing Ponseti treatment. J Bone Joint Surg Am 89:1177–1183
Desai S, Aroojis A, Mehta R (2008) Ultrasound evaluation of clubfoot correction during Ponseti treatment: a preliminary report. J Pediatr Orthop 28:53–59
El-Adwar KL, Taha Kotb H (2010) The role of ultrasound in clubfoot treatment: correlation with the Pirani score and assessment of the Ponseti method. Clin Orthop Relat Res 468:2495–2506
Agarwal A, Qureshi NA, Kumar P et al (2012) Ultrasonographic evaluation of Achilles tendons in clubfeet before and after percutaneous tenotomy. J Orthop Surg 20:71–74
Marleix S, Chapuis M, Fraisse B et al (2012) Idiopathic club foot treated with the Ponseti method. Clinical and sonographic evaluation of Achilles tendon tenotomy. A review of 221 club feet. Orthop Traumato Surg Res 98:S73–S76
Niki H, Nakajima H, Hiramo T et al (2013) Ultrasonographic observation of the healing process in the gap after a Ponseti-type Achilles tenotomy for idiopathic congenital clubfoot at two-year follow-up. J Orthop Sci 18:70–75
Coley BD, Shiels WE 2nd, Kean J et al (2007) Age-dependent dynamic sonographic measurement of pediatric clubfoot. Pediatr Radiol 37:1125–1129
Aurell Y, Adlercreutz C, Andriesse H et al (2004) Repeatability of sonographic measurements in clubfeet. Acta Radiol 45:622–627
Ponseti V (1996) Congenital clubfoot: fundamentals of treatment, 2nd edn. Oxford University Press, Oxford
Katz DA, Albanese EL, Levinsohn EM et al (2003) Pulsed color-flow Doppler analysis of arterial deficiency in idiopathic clubfoot. J Pediatr Orthop 23:84–87
Greene WB (1994) Metatarsus adductus and skewfoot. Instr Course Lect 43:161–177
Lepow GM, Lepow RS, Lepow RM et al (1987) Pediatric metatarsus adductus angle. J Am Podiatr Med Assoc 77:529–532
Berg EE (1986) A reappraisal of metatarsus adductus and skewfoot. J Bone Joint Surg Am 68:1185–1196
Cavalier R, Lipton GE, Bowen JR (1997) Radiologic case study. Skewfoot. Orthopedics 20:728–736
Hutchinson B (2010) Pediatric metatarsus adductus and skewfoot deformity. Clin Podiatr Med Surg 27:93–104
Bleck EE (1983) Metatarsus adductus: classification and relationship to outcomes of treatment. J Pediatr Orthop 3:2–9
Mosca VS (1992) Flexible flatfoot and skewfoot. In: Drennan JC (ed) The child's foot and ankle. Raven, New York, pp 355–376
Vanderwilde R, Staheli LT, Chew DE et al (1988) Measurements on radiographs of the foot in normal infants and children. J Bone Joint Surg Am 70:407–415
Cook DA, Breed AL, Cook T et al (1992) Observer variability in the radiographic measurement and classification of metatarsus adductus. J Pediatr Orthop 12:86–89
Dawoodi AI, Perera A (2012) Radiological assessment of metatarsus adductus. Foot Ankle Surg 18:1–8
Hunziker UA, Largo RH, Duc G (1988) Neonatal metatarsus adductus, joint mobility, axis and rotation of the lower extremity in preterm and term children 0–5 years of age. Eur J Pediatr 148:19–23
Kite JH (1967) Congenital metatarsus varus. J Bone Joint Surg Am 49:388–397
Peabody CW, Muro F (1933) Congenital metatarsus varus. J Bone Joint Surg Am 15:171–189
McCormick DW, Blount WR (1949) Metatarsus adductovarus: skewfoot. J Am Med Assoc 141:449–453
Napiontek M (2002) Skewfoot. J Pediatr Orthop 22:130–133
Hagmann S, Dreher T, Wenz W (2009) Skewfoot. Foot Ankle Clin 14:409–434
Jawish R, Rigault P, Padovani JP et al (1990) The Z-shaped or serpentine foot in children and adolescents. Chir Pediatr 31:314–321
Wan SC (2006) Metatarsus adductus and skewfoot deformity. Clin Podiatr Med Surg 23:23–40
Peterson HA (1986) Skewfoot (forefoot adduction with heel valgus). J Pediatr Orthop 6:24–30
Hubbard AM, Davidson RS, Meyer JS et al (1996) Magnetic resonance imaging of skewfoot. J Bone Joint Surg Am 78:389–397
McKie J, Radomisli T (2010) Congenital vertical talus: a review. Clin Podiatr Med Surg 27:145–156
Alaee F, Boehm S, Dobbs MB (2007) A new approach to the treatment of congenital vertical talus. J Child Orthop 1:165–174
Benard MA (2000) Congenital vertical talus. Clin Podiatr Med Surg 17:471–480
Jacobsen ST, Crawford AH (1983) Congenital vertical talus. J Pediatr Orthop 3:306–310
Kumar SJ, Cowell H, Ramsey PL (1982) Vertical and oblique talus. Instr Course Lect 31:235–251
Harris EJ (2000) The oblique talus deformity. What is it, and what is its clinical significance in the scheme of pronatory deformities? Clin Podiatr Med Surg 17:419–442
Schlesinger AE, Deeney VF, Caskey PF (1989) Sonography of the nonossified tarsal navicular cartilage in an infant with congenital vertical talus. Pediatr Radiol 20:134–135
Supakul N, Loder RT, Karmazyn B (2013) Dynamic US study in the evaluation of infants with vertical or oblique talus deformities. Pediatr Radiol 43:376–380
Violas P, Chapuis M, Tréguier C et al (2006) Ultrasound: a helpful technique in the analysis of congenital vertical talus. A case report. J Pediatr Orthop B 15:70–72
Dobbs MB, Purrell DB, Nunley R et al (2006) Early results of a new method of treatment for idiopathic congenital vertical talus. J Bone Surg Am 88:1192–1200
Acknowledgments
The authors wish to thank Ramy El-Jalbout, MD, Laurent Garel, MD, and Alain Sirard, MD, for perusing the draft of this work, Madeleine Leduc for the medical illustrations, Stephane Dedelis for the image processing, and Liette Bigras for the technical support.
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Miron, MC., Grimard, G. Ultrasound evaluation of foot deformities in infants. Pediatr Radiol 46, 193–209 (2016). https://doi.org/10.1007/s00247-015-3460-3
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DOI: https://doi.org/10.1007/s00247-015-3460-3