Arthrography as a Guide in the Treatment of Congenital Clubfoot: Findings and Treatment Results in a Consecutive Series

Abstract

Simultaneous arthrography of the talocrural and talonavicular joints performed on 32 out of a consecutive series of 48 congenital clubfeet revealed a talar dysplasia that varied considerably both in type and degree.

This great variability meant that no simple and practically useful classification could be made on the basis of arthrographic findings. It indicated, further, that the deformation forces varied correspondingly. Each case therefore has to be analysed separately and treated individually.

The primary treatment was conservative in all cases, but 28 feet were later operated upon because of unsatisfactory correction or recurrence. the operations varied in extent from lengthening of the tendo Achillis to extensive soft-tissue procedures, in some cases combined with correction osteotomy through the neck of the talus and the calcaneus. the results were relatively good, but the investigation showed that in many cases the talar dysplasia places a definite limit on the achievable result.

Arthrography is not indicated in easily corrigible cases. This examination should always be carried out, however, in clubfeet that are difficult to correct or are recurrent, before making a decision about surgical treatment. in these cases the arthrographic findings can be used as a guide in the choice of therapeutic method. the talar dysplasia seems not to alter appreciably during the first year of life, and it would therefore seem appropriate and advisable to perform the examination, and if necessary the operation, at the age of 6–12 months. A programme for examination and treatment is briefly described.

Key Words:

• ankle joint
• clubfoot
• radiography
• talus
• therapy