Magnetic resonance imaging of the congenital clubfoot treated with the French functional (physical therapy) method

Abstract

The purpose of this study was to assess magnetic resonance imaging (MRI) changes that occur in clubfeet after nonoperative treatment with the French functional method, specifically pertaining to the chondro-osseous anatomy and the joint relationships. The magnetic resonance images were obtained in 6 infants before treatment and 3 months later. The MRI protocol described previously for clubfeet which were treated by the Ponseti method (J Pediatr Orthop. 2001;21:719) was closely adhered to, except that no sedation was allowed by our institutional review board. The severity of the clubfoot deformities before treatment made assessment of the tibiotalar, talonavicular, and talocalcaneal joint relationships difficult in some feet. Despite this, improvements were noted after treatment in tibiotalar plantarflexion, the talonavicular relationship, the calcaneocuboid relationship, and the varus position of the calcaneus. The wedge shape of both the navicular and distal end of the calcaneus that occasionally was noted on the MRI before treatment improved after therapy. Although improved clinically, persistent equinus of the calcaneus on MRI was significant in 2 feet and was associated with slight dorsal displacement of the cuboid on the calcaneus (MRI evidence of rocker bottom). As noted with use of the Ponseti nonoperative treatment method, the chondro-osseous abnormalities seen on MRI studies in congenital clubfoot improve after treatment with the French functional (physical therapy) method, with the exception of equinus.