Abstract
The outcome of surgical treatment for congenital clubfoot depends, among other things, on obtaining correct repositioning of the tarsus in relation to the talus, i.e., peritarsal correction. This correction includes successfully repositioning the navicular, which is dislocated medially in relation to the head of the talus.
Evaluation of talonavicular repositioning is possible in older children when it is possible to observe the navicular bone on a radiograph. In radiographs of younger children between the ages of three and five, the navicular bone cannot be seen. USG examination may be helpful in the evaluation of talonavicular positioning, enabling better planning of the surgical procedure and its range.
In the Paediatric Orthopaedic Department of Medical Academy in Lublin from 1995 to 1999, 225 children (256 feet) were surgically treated. The peritarsal correction method (Turco) was used to manage 221 feet, and 31 feet by the subtalar release method according to Crawford by the incision of Cincinnati. Fifty-two feet were re-operated because of recurrent deformation.
USG examinations revealed incorrect positioning of the navicular bone. There was medial displacement in 24 feet (recurrent deformations), and wedge-shaped navicular bone in 18 feet and connected with dorsal displacement (overcorrection).
Medial displacements were observed in residual adductus deformation, whereas dorsal displacements were observed in feet with cavus or calcaneal deformity, which is connected with excessive lengthening of the calcaneal tendon (overcorrection).
USG examination in recurrent clubfoot enables the evaluation of talonavicular repositioning (not possible on radiographs) in younger children two to five years old, and is helpful to better plan the range of the operation.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
