Evaluation of structural changes in tarsal bones following complete subtalar release for congenital clubfoot
Önder Kalenderer1, Haluk Ağuş1, Aziz Vatansever2, Serkan Özlük1, Hüseyin Şentürk3
1İzmir Tepecik Araştırma ve Eğitim Hastanesi II Ortopedi ve Travmatoloji Kliniği
2Celal Bayar Üniversitesi Tıp Fakültesi Hastanesi, Ortopedi ve Travmatoloji Anabilim Dalı
3Celal Bayar Üniversitesi Tıp Fakültesi Hastanesi,Radyoloji Anabilim Dalı
Keywords: Child; clubfoot/surgery/radiography; talus/radiography; tarsal joints/radiography; tomography, X-ray computed/ methods.
Objectives: We evaluated the mid-term radiologic changes in tarsal bones by computed tomography (CT) in patients in whom complete subtalar release for congenital unilateral clubfoot resulted in a successful outcome.
Patients and methods: The study included nine patients (4 girls, 5 boys; mean age 12 years; range 9 to 14 years) who underwent complete subtalar release for congenital unilateral clubfoot between 1990 and 1995. According to the Simons criteria, a satisfactory outcome was obtained in all the patients. After a mean follow-up of 10.5 years (range 8 to 13 years), all the feet were studied by plain radiographs and standard and three-dimensional CT. Changes in tarsal bones were evaluated and compared with the normal side.
Results: Axial CT scans showed dorsal navicular subluxation in eight feet, wedge-shape formation in the navicular bone in seven feet, flattening of the talar head in four feet, flattening of the lateral part of the navicular bone in three feet, narrowing of the talonavicular joint distance in two feet, and decrease in the talonavicular contact area in two feet. Significant differences were found between the operated and the contralateral feet with respect to the mean volumes of the talus (24.0 mm3 vs 29.3 mm3,p=0.008) and the navicular bone (7.0 mm3 vs 8.5 mm3, p=0.01).
Conclusion: Structural changes in tarsal bones may occur following surgical treatment of congenital unilateral clubfoot despite achievement of satisfactory clinical and functional results. Further studies are required to understand how these changes will influence the clinical condition of the foot in the long-term.