Role of Ultrasonography as a Prognostic Tool for the Treatment of Idiopathic Clubfoot by Ponseti Technique: A Systematic Review of Literature

JOURNAL TITLE: Journal of Foot and Ankle Surgery (Asia Pacific)

Author
1. Aman Hooda
2. Prasoon Kumar
ISSN
2348-280X
DOI
10.5005/jp-journals-10040-1086
Volume
5
Issue
1
Publishing Year
2018
Pages
4
Author Affiliations
    1. Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
    1. Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • Article keywords
    Clubfoot, Ponseti, Prognosis, Talonavicular, Ultrasonography

    Abstract

    Introduction: Modern nonoperative treatment of idiopathic clubfoot consists of the Ponseti technique of manipulation and serial casting. Most patients have an excellent long-term outcomes with minimal pain or disability; however, some patients fail to respond or relapse after initial correction. The challenge is to identify such probable resistant or failed cases, and the factors that determine the same. Ultrasonography (USG) is being explored for the diagnosis and follow-up of clubfoot cases. Research question: Does USG help in prognosticating the effectiveness of Ponseti method in clubfoot correction? Materials and methods: Based on a PubMed search, articles related to usage of USG as a tool to prognosticate the Ponseti method were evaluated over a period of last 10 years. Five studies were identified and assessed. Based on this evaluation, parameters were extracted that could reliably indicate the prognosis. Conclusion: Ultrasonography seems to be a cheap and effective tool to identify and calculate factors like tarsal dysplasia, talonavicular (TN) angle, talocuneiform angle (TCu), and the medial malleolus navicular distance (MMND) that could be evaluated before starting treatment and serially during its course. A low MMND and TN angle or a dysplastic talus indicates stiffness and poor prognosis. A serial increase in MMND and TN angle indicates adequate maintenance of correction. So, these parameters measured by USG could be used to prognosticate the effectiveness of the Ponseti method.

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