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Ultrasound anatomy in the normal neonatal and infant foot: an anatomic introduction to ultrasound assessment of foot deformities.
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2002 (English)In: European Radiology, ISSN 0938-7994, Vol. 12, no 9, 2306-12 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to establish guidelines for US assessment of the talo-crural, the talo-navicular and the calcaneo-cuboid joints during the first year of life, which could serve as a reference while studying foot deformities. The feet of 54 healthy children were examined at birth and at the age of 4, 7 and 12 months by using three easily defined and reproducible US projections. With a medial projection the relation of the navicular in relation to the medial malleolus and the head of the talus was studied. A lateral projection revealed the calcaneo-cuboid relationship and a dorsal projection the talo-navicular alignment in the sagittal plane. Normal values for measurements of these cartilaginous relationships were established for the different age groups. Intra- and inter-observer reliability was assessed and found to be acceptable ( r=0.53-0.90, Pearson correlation coefficient). With US it is possible to obtain reproducible planes of investigation that give reliable information about the talo-crural, the talo-navicular and the calcaneo-cuboid relationships during the first year of life.

Place, publisher, year, edition, pages
2002. Vol. 12, no 9, 2306-12 p.
URN: urn:nbn:se:uu:diva-105166DOI: 10.1007/s00330-001-1243-8PubMedID: 12195486OAI: oai:DiVA.org:uu-105166DiVA: diva2:220611
Available from: 2009-06-01 Created: 2009-06-01 Last updated: 2009-06-01
In thesis
1. Congenital clubfoot: Aspects on epidemiology, residual deformity and patient reported outcome
Open this publication in new window or tab >>Congenital clubfoot: Aspects on epidemiology, residual deformity and patient reported outcome
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis on congenital clubfoot was to estimate the incidence with a national perspective, analyse residual deformities and their management, and evaluate patient reported long-term quality of life and foot function.

Paper I was a prospective, nationwide sampling of 280 children with congenital clubfoot during 1995-96. The average incidence was 1.4‰. There was regional heterogeneity but no seasonal variation.

Paper II evaluated ultrasonography on 54 newborn, prospectively followed up to 12 months of age. Significant increase of medial malleolus to navicular distance (MM-N-distance) and of soft tissue thickness with increasing age was seen and with acceptable reliability.

Paper III assessed 35 children (47 feet) after previous posterior release, mean age of 4.5 years, and the MM-N-distance was shorter in unilateral clubfeet (21 patients) than in contralateral normal feet. No association between navicular position and forefoot adduction (FFA) was determined. Smaller FFA yielded better subjective and functional outcome.

Paper IV reviewed distraction treatment with Ilizarov External Fixator in seven patients (10 feet), 6-15 years of age, with relapsed deformities. All patients, except one, reported satisfaction with the overall result but less stiffness was experienced in only 4/10 feet.

Paper V evaluated self-estimated outcome in 83 patients (63 males, 20 females), mean age of 64 years, through SF-36 and EQ-5D, and through AAOS foot and ankle score. Age and gender adjusted norm groups were used. Female patients scored worse than male patients did. Both males and females reported negative influence on foot and ankle function.

Conclusion: The incidence of congenital clubfoot in Sweden is higher than in previous Scandinavian studies. Ultrasonography is reliable for describing pathoanatomy of the talo-navicular joint in clubfeet and can detect "spurious" (false) correction. Distraction treatment with the Ilizarov External Fixator yields subjective improvement but stiffness remains. Long-term influence on daily life activities is limited to foot and ankle function for both genders, but only female patients report negative influence on physical aspects of quality of life.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 48 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 464
Congenital clubfoot, incidence, ultrasonography, forefoot adduction, navicular position, spurious correction, Ilizarov External Fixator, subjective outcome, stiffness, patient reported outcome, norm group, gender difference
National Category
Research subject
urn:nbn:se:uu:diva-106366 (URN)978-91-554-7563-5 (ISBN)
Public defence
2009-10-03, Brömssalen, Gävle Sjukhus, Gävle, 13:00 (English)
Available from: 2009-09-11 Created: 2009-06-22 Last updated: 2009-09-11Bibliographically approved

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