This retrospective analysis aimed to assess the effectiveness of Split Tibialis Anterior Tendon Transfer (Split TATT) in treating residual idiopathic congenital talipes equinovarus (CTEV) deformities.

15 patients (20 feet) with CTEV, with a mean age of 6.4 ± 3.2 years, initially treated with Ponseti casting, underwent Split TATT. Clinical and radiological evaluations, including Diméglio and Garceau scores, dorsiflexion, and X-ray measurements, were conducted preoperatively and post-operatively at a minimum 2-year follow-up.

Significant improvements were observed in Diméglio and Garceau scores. Dorsiflexion increased by an average of 3°, and radiological analysis revealed nuanced changes. Despite a weak Kappa coefficient, positive trends in dorsiflexion and Garceau scores were noted. Preoperative Garceau scores did not reliably predict postoperative results.

Split TATT demonstrates promising results in improving muscular balance and functional outcomes in CTEV. While radiological changes are subtle, positive trends in clinical scores indicate meaningful outcomes.

IV Retrospective study.

Congenital talipes equinovarus (CTEV), also known as clubfoot, is a common musculoskeletal entity that affects one to two per 1000 live births worldwide. Imaging modalities including radiography, US, and MRI have emerged as valuable tools for the diagnosis, treatment, and monitoring of CTEV. The deformity is characterized by midfoot cavus, forefoot adductus, and hindfoot varus and equinus. The Ponseti method of manipulation and serial casting is the standard treatment of CTEV. Radiography shows the anatomy, position, and relationships of the different bones of the foot. US allows accurate assessment of cartilaginous and bony structures, in addition to its inherent advantages such as absence of ionizing radiation exposure. One of the indications for US is to monitor the response to Ponseti method treatment. MRI enables visualization of bones, cartilage, and soft tissues and allows multiplanar evaluation of deformities, providing a comprehensive imaging analysis of CTEV. An integrated approach that combines clinical examination and imaging findings is essential for effective management of CTEV. The authors provide a comprehensive overview of CTEV with a review of imaging modalities to help evaluate CTEV, focusing on radiography, US, and MRI. Using this article as a guide, radiologists involved in the assessment and treatment of CTEV can contribute to the management of the condition. ©RSNA, 2024 Supplemental material is available for this article.

The lack in consensus with regard to qualitative use of standard radiographs and their predictive value in evaluating congenital talipes equinovarus among infants continues to be apparent in clinical practice. Since standard radiographs continue to play a role in the assessment of clubfoot it is essential to ensure that the values measured are reliable and reproducible keeping in mind acceptable tolerances for clinical application. This study was undertaken to assess the inter-observer and the intra-observer reliability in estimation of talocalcaneal and talo-first metatarsal angles on standard radiographs done according to Simon's method. The study was conducted by consecutively selecting eleven children with unilateral idiopathic congenital clubfoot who presented to our tertiary care hospital with a paediatric orthopaedic service unit. Only those with unilateral idiopathic clubfoot with persistent deformity at the age of 3 months were included. The data obtained from three observers on two separate occasions was analysed by the method proposed by Bland and Altman to assess intra and inter observer variability in the measurements. The results of the present study suggest a significant difference between the measurements on two occasions by the same observer. The difference was constant and the level of experience of the observer had no significance. Also, there was a marked inter observer variability as evident from the calculation of limit of agreement. Therefore, radiological assessment of the type and degree of malalignment in these cases is insufficient as it does not possess the accuracy required in evaluation and further management.

To compare the functional outcomes of patients who underwent open surgery vs Ponseti method for the management of idiopathic clubfoot and to determine whether correlations exist between functional outcome and radiographic measurements.

A meta-analysis of the literature was conducted for studies concerning primary treatment of patients with idiopathic clubfoot. We searched PubMed Medline, EMBASE, and the Cochrane Library databases from January 1950 to October 2011. Meta-analyses were performed on outcomes from 12 studies. Pooled means, SDs, and sample sizes were either identified in the results or calculated based on the results of each study.

Overall, 835 treated idiopathic clubfeet in 516 patients were reviewed. The average follow-up was 15.7 years. Patients managed with Ponseti method did have a higher rate of excellent or good outcome than patients treated with open surgery (0.76 and 0.62, respectively), but not quite to the point of statistical significance (Q = 3.73, P = 0.053). Age at surgery was not correlated with the functional outcome for the surgically treated patients (r = -0.32, P = 0.68). A larger anteroposterior talocalcaneal angle was correlated with a higher rate of excellent or good outcomes (r = 0.80, P = 0.006). There were no other significant correlations between the functional and radiographic outcomes.

The Ponseti method should be considered the initial treatment of idiopathic clubfeet, and open surgery should be reserved for clubfeet that cannot be completely corrected.

Even today there are still some cases of clubfoot that require a more extensive form of treatment. Thus, it is still essential to ascertain the development of the clubfoot after extensive release operations.

70 children presenting 99 cases of primary clubfoot (age 8 months-10 years) were followed up after 4.5 and 9 years following complete subtalar release. Function, clinical and radiological results as well as 3 scores were assessed at both dates.

Function and pain worsened between the two follow-up periods, whereas objective clinical and radiological results remained equivalent. 44-79% were rated good or excellent depending on the scoring system applied.Older children with primary clubfoot had comparable results to children operated on at a younger age; also pre-operated feet achieved similar results.

In our opinion the results justify keeping complete release in mind as an alternative method in cases of severe residual and recurrent clubfoot.

One hundred thirty-three resistant congenital clubfeet in 93 patients between 3 and 10 months of age were operated on using a standardized posteroplantar release. Clinical and radiographic assessments were done with a mean followup of 7 years 4 months (range, 3-12 years). Using the McKay score, 79.7% of the surgically treated clubfeet were classified as having a good or excellent result. Three patients had relapse of their clubfoot that required additional surgery. Seventeen feet in 15 patients had residual forefoot adduction at the time of followup. The radiographs showed that the early posteroplantar release led to sufficient hindfoot correction in all but the three patients who had relapse of the clubfoot. With this standardized surgical treatment, satisfactory results can be achieved in most patients younger than 1 year with congenital clubfoot. However, in patients with persistent talonavicular subluxation after conservative treatment, an additional talonavicular release combined with the posteroplantar release is recommended.