Radiological assessment of idiopathic club foot treated with ponseti technique

Introduction: Idiopathic club foot is primarily treated by Ponseti technique of serial manipulation and casting. Ponseti recommended evaluation of club foot by palpation, but it is subjective, dependent on clinical experience and limited by inter-observer variability. Aim: To assess the deformities and amount of correction achieved after the treatment using radiographs obtained before and after treatment. Materials and Methods: A non-randomized, interventional study was done among patients with idiopathic club foot treated by Ponseti method. Radiographs including the anteroposterior and lateral projections in maximum dorsiflexion of foot were taken at presentation and after completion of treatment. Five parameters, i.e., the Anteroposterior (TCA-AP) and Lateral Talo-Calcaneal Angle (TCA-LT), Anteroposterior Talo-First Metatarsal Angle (TMT-AP), Lateral Tibio-Calcaneal Angle (TiC-LT) and Talo-Calcaneal Index (TCI) were measured and analysed. The Student’s paired t-test was used to compare the variables before and after treatment and a p-value of less than 0.05 was considered significant. Results: There was a statistically significant improvement in the mean values of the five parameters after treatment when compared with the values on presentation.The Anteroposterior Talo-Calcaneal Angle (TCA-AP) before treatment had a mean value of 21.4 and after treatment had a mean value of 33.82° (p-value <0.05). The TMT-AP had a mean value of 29.07° & 2.14° following treatment (p-value <0.05). The TCA-LT had a mean of 18.05° prior to treatment & 34° after correction (p-value <0.05). The TCI had a mean of 39.41° before treatment & 67.82° after treatment (p-value<0.05). The TiC-LT at presentation had a mean value of 102.95° & 64.31 after treatment (p-value <0.05). Conclusion: Analytical radiology of club foot is a reliable method of evaluation of the treatment and tends to be more objective and critical when multiple parameters are considered.