Published online Nov 18, 2022. doi: 10.5312/wjo.v13.i11.986
Peer-review started: August 29, 2022
First decision: October 24, 2022
Revised: October 29, 2022
Accepted: November 2, 2022
Article in press: November 2, 2022
Published online: November 18, 2022
The goal of treatment for pediatric idiopathic clubfoot is to enable the patient to comfortably walk on his or her soles without pain. However, currently accepted treatment protocols are not always successful. Based on the abnormal bone alignment reported in this disease, some studies have noted a correlation between radiographic characteristics and outcome, but this correlation remains debated.
To assess the correlation between immediately postoperative radiographic parameters and functional outcomes and to identify which best predicts func
To predict the outcome and prevent early failure of the Ponseti’s method, we used a simple radiographic method to predict outcome. Our study included newborns with idiopathic clubfoot treated with Ponseti’s protocol from November 2018 to August 2022. After Achilles tenotomy and a long leg cast were applied, the surgeon obtained a single lateral radiograph. Radiographic parameters included the tibiocalcaneal angle (TiCal), talocalcaneal angle (TaCal), talofirst metatarsal angle (Ta1st) and tibiotalar angle (TiTa). During the follow-up period, the Dimeglio score and functional score were examined 1 year after surgery. Additionally, recurring events were reported. The correlation between functional score and radiographic characteristics was analyzed using sample and multiple logistic regression, and the optimal predictor was also identified.
In total, 54 feet received approximately 8 manipulations of casting and Achilles tenotomy at a mean age of 149 days. The average TiCal, TaCal, Ta1st, and TiTa angles were 75.24, 28.96, 7.61, and 107.31 degrees, respectively. After 12 mo of follow up, we found 66% excellent-to-good and 33.3% fair-to-poor functional outcomes. The Dimeglio score significantly worsened in the poor outcome group (P value < 0.001). Tical and TaCal showed significant differences between each functional outcome (P value < 0.05), and the TiCal strongly correlated with outcome, with a smaller angle indicating a better outcome, each 1 degree decrease improved the functional outcome by 10 percent. The diagnostic test revealed that a TiCal angle of 70 degrees predicts an inferior functional outcome.
The TiCal, derived from lateral radiographs immediately after Achilles tenotomy, can predict functional outcome at 1 year postoperatively, justifying its use for screening patients who need very close follow-up.
Core Tip: Idiopathic clubfoot is an abnormality of bone alignment. Current treatment strategies are associated with recurrence, which results in pain and poor quality of life. Radiography-assisted outcome prediction must be harmless in young children. The lateral tibiocalcaneal angle was directly related to functional outcomes, as a smaller angle was associated with a better outcome. A lateral tibiocalcaneal angle exceeding 70 degrees immediately after Achilles tenotomy predicted an inferior outcome.