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. 2019 Jun 1;13(3):265-270.
doi: 10.1302/1863-2548.13.190080.

Delayed ossification and abnormal development of tarsal bones in idiopathic clubfoot: should it affect bracing protocol when using the Ponseti method?

Y Hemo  1 , R Gigi  1 , S Wientroub  1
Affiliations

Delayed ossification and abnormal development of tarsal bones in idiopathic clubfoot: should it affect bracing protocol when using the Ponseti method?

Y Hemo et al. J Child Orthop. .

Abstract

Purpose: To point out the need to take into account the dysplastic nature of tarsal bones when treating idiopathic clubfoot (CF).

Methods: Review the published evidence on the developmental abnormalities of tarsal bones in idiopathic CF.

Results: The literature review provides abundant proof of the existence of delayed appearance and slower development of ossification centres of tarsal bones in idiopathic clubfoot.

Conclusion: Gentle manipulations and casting are the cornerstone of the Ponseti method. The biological response of all foot elements is critical for a successful outcome. Delayed ossification and abnormal development of tarsal bones in idiopathic CF may affect the results. Development of a personalized tailored bracing protocol based on severity assessment and response to casting treatment will improve results and quality of care in CF management.

Level of evidence: V.

Keywords: Ponseti; clubfoot; ossification; tarsal abnormalities.

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Figures

Fig. 1
Fig. 1
Anteroposterior radiograph of both feet taken together of a three-year-old boy with a unilateral (R) clubfoot treated according to the Ponseti method. Note the size differences of the cuboid and the cuneiforms between the affected (R) and the non-affected (L) foot. The ossification centre of the affected tarsal navicular and intermediate cuneiform are not ossified yet.
Fig. 2
Fig. 2
Anteroposterior radiographs of both feet taken together of a three-year-old boy with a unilateral (L) clubfoot treated according to the Ponseti method. The navicular and intermediate cuneiform ossification centres are not seen yet.
Fig. 3
Fig. 3
Lateral standing radiographs of a six-year-old boy treated for left clubfoot according to the Ponseti method. Note that the ossification centre of tarsal navicular bone is just appearing in the affected foot (L).
Fig. 4
Fig. 4
Anteroposterior radiographs of both feet taken together of a three-year-old boy with a unilateral (L) clubfoot treated according to the Ponseti method. Note that all ossification centres of tarsal bones can be seen in the non-affected foot (R) but not in the affected foot (L). There is a size different between the tarsal bones of the affected and the non-affected bones.
See this image and copyright information in PMC

References

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