Skip to main content

Advertisement

SpringerLink
Log in

CT Study on the Effect of Different Treatment Protocols for Clubfoot Pathology

  • Symposium: Clubfoot: Etiology and Treatment
  • Published:
Clinical Orthopaedics and Related Research

Abstract

In congenital clubfoot, residual deformities are not well-documented and they may change depending on different treatments. To identify the treatment that provides better outcome at maturity, we studied the computed tomography of two cohorts of patients affected with congenital clubfoot who were treated using two distinct protocols. Forty-seven clubfeet were treated according to the traditional protocol of our hospital and 61 were treated according to the Ponseti technique. The normal feet of the unilateral deformities served as controls. All patients were followed to skeletal maturity. The ankle torsion angle and the declination angle of the neck of the talus were higher than normal but different only in patients treated with the traditional method. The calcaneocuboid angle was lower but only in patients treated with the Ponseti method. The shape of the talar joints was altered in many feet regardless of protocol. The CT images suggest the modifications of the torsion angle of the ankle, the declination angle of the neck of the talus, and the calcaneocuboid angle at maturity are related to the treatment protocol followed. The Ponseti manipulative technique provided better anatomical results in comparison to our traditional technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–C
Fig. 2A–C
Fig. 3A–B
Fig. 4A–C
Fig. 5A–B

Similar content being viewed by others

References

  1. Codivilla A. Sulla cura del piede equino varo congenito: nuovo metodo di cura cruenta. [Congenital talipes equinovarus: a new method of surgical treatment]. Arch Chir Orthop. 1906;23:245–258.

    Google Scholar 

  2. Farsetti P, Caterini R, Mancini F, Potenza V, Ippolito E. Anterior tibial tendon transfer in relapsing congenital clubfoot. J Pediatr Orthop. 2006;26:83–90.

    Article  PubMed  Google Scholar 

  3. Howard CB, Benson MKD. Clubfoot: its pathological anatomy. J Pediatr Orthop. 1993;13:654–659.

    PubMed  CAS  Google Scholar 

  4. Ippolito E, Farsetti P, Caterini R, Tudisco C. Long-term comparative results in patients with congenital clubfoot treated with two different protocols. J Bone Joint Surg Am. 2003;85:1286–1294.

    PubMed  Google Scholar 

  5. Ippolito E, Fraracci L, Caterini R, Di Mario M, Farsetti P. A radiographic comparative study of two series of skeletally mature clubfeet treated by two different protocols. Skeletal Radiol. 2003;32:446–453.

    Article  PubMed  CAS  Google Scholar 

  6. Ippolito E, Fraracci L, Farsetti P, De Maio F. Validity of the anteroposterior talocalcaneal angle to assess congenital clubfoot correction. AJR Am J Roentgenol. 2004;182:1279–1282.

    PubMed  CAS  Google Scholar 

  7. Ippolito E, Fraracci L, Farsetti P, Di Mario M, Caterini R. The influence of treatment on skeletal pathology of clubfoot. CT study at maturity. J Bone Joint Surg Br. 2004;86:574–580.

    PubMed  CAS  Google Scholar 

  8. Ippolito E, Mancini F, Di Mario M, Farsetti P. A comparison of resultant subtalar joint pathology with functional results in two groups of clubfoot patients treated with two different protocols. J Pediatr Orthop B. 2005;14:358–361.

    PubMed  Google Scholar 

  9. Ippolito E, Ponseti IV. Congenital clubfoot in the human fetus: a histological study. J Bone Joint Surg Am. 1980;62:8–18.

    PubMed  CAS  Google Scholar 

  10. Irani RN, Sherman MS. The pathological anatomy of clubfoot. J Bone Joint Surg Am. 1963;45:45–52.

    Google Scholar 

  11. Jacob RP, Haertel M, Stussi E. Tibial torsion calculated by computerized tomography and compared to other methods of measurements. J Bone Joint Surg Br. 1980;62:238–242.

    Google Scholar 

  12. Johnston CE 2nd, Hobatho MC, Baker KJ, Baunin C. Three-dimensional analysis of clubfoot deformity by computed tomography. J Pediatr Orthop B. 1995;4:39–48.

    PubMed  Google Scholar 

  13. Manes E, Costa CM, Innao V. Treatment of congenital clubfoot during the first years of life. Chir Organi Mov. 1975;62:301–314.

    PubMed  CAS  Google Scholar 

  14. Marino-Zuco C. Trattamento del piede torto congenito [Treatment of congenital clubfoot]. Roma Arte della Stampa. 1934:9–28.

  15. Pirani S, Zenznik L, Hodges D. Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method. J Pediatr Orthop. 2001;21:719–726.

    Article  PubMed  CAS  Google Scholar 

  16. Ponseti IV. Congenital Clubfoot: Fundamentals and Treatment. New York, NY: Oxford University Press; 1996.

    Google Scholar 

  17. Ponseti IV, El-Khoury GY, Ippolito E, Weinstein SL. A radiographic study of skeletal deformities in treated clubfoot. Clin Orthop Relat Res. 1981;160:30–42.

    PubMed  Google Scholar 

  18. Ponseti IV, Smoley EN. Congenital clubfoot: the results of treatment. J Bone Joint Surg Am. 1963;45:261–275.

    Google Scholar 

  19. Settle GW. The anatomy of congenital talipes equinovarus: sixteen dissected specimens. J Bone Joint Surg Am. 1963;45:1341–1354.

    PubMed  CAS  Google Scholar 

  20. Turco VJ. Resistant congenital clubfoot treated by one stage posteromedial release with internal fixation: a follow-up report with a fifteen years experience. J Bone Joint Surg Am. 1979;61:805–814.

    PubMed  CAS  Google Scholar 

  21. Waisbrod H. Congenital clubfoot: an anatomical study. J Bone Joint Surg Br. 1973;55:796–801.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Dr Giovanna Brancato of the Italian Institute of Statistics (ISTAT) for the statistical analysis.

Author information

Authors and Affiliations

  1. Departments of Orthopaedic Surgery and Radiology, University of Rome Tor Vergata, Rome, Italy

    Pasquale Farsetti MD, Fernando De Maio MD, Laura Russolillo MD & Ernesto Ippolito MD

  2. Department of Orthopaedics, University Hospital Tor Vergata, Viale Oxford, 81-00133, Rome, Italy

    Ernesto Ippolito MD

Authors
  1. Pasquale Farsetti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fernando De Maio MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Russolillo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ernesto Ippolito MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ernesto Ippolito MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Farsetti, P., De Maio, F., Russolillo, L. et al. CT Study on the Effect of Different Treatment Protocols for Clubfoot Pathology. Clin Orthop Relat Res 467, 1243–1249 (2009). https://doi.org/10.1007/s11999-008-0699-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-008-0699-0

Keywords

Search

Navigation