ROLE OF ULTRASOUND AS PROGNOSTIC INDICATOR DURING PRONSETI CORRECTION

Abstract

Objective: Clubfoot ultrasonography is an objective means of determining severity. The purpose of this study is to evaluate the reliability of measuring clubfoot severity by sonographic evaluation of the talonavicular angle (TNA) and the reliability of assessing angle change on simulated Ponseti manipulation. Methods: Twenty-six infants with unilateral idiopathic clubfoot were evaluated prospectively using clinical scoring and Pirani scoring and sonographic measurements of TNA at the start of treatment, after midfoot correction, and after the complete correction was achieved. The TNA and its change during simulated Ponseti manipulation were recorded. Results: In static posture, the mean TNA of the clubfoot (66.46°) differed substantially from that of the contralateral normal foot (101.3°). The mean shift in TNA after simulated Ponseti manipulation was 22.54° (5-50°), and it correlated negatively with clinical ratings and the total number of casts required for final correction (p<0.05). Linear regression research demonstrated that the change in TNA on simulated Ponseti manipulation was the strongest predictor of treatment outcome in CTEV (with a prediction of 60% compared to 25% for Pirani scores). Conclusion: The severity of clubfoot in babies can be better accessed via sonographic examination of TNA and change in TNA following simulated Ponseti manipulation. This objective form of assessment is less expensive, more reproducible in clinical settings, and can better predict treatment outcomes.