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VOLUME 46 , ISSUE 4 ( October-December, 2012 ) > List of Articles


Is Sonographic Calculation of Talonavicular Angle During Ponseti Correction of Clubfoot a Reliable Prognostic Indicator?

Naveen Gupta, Pebam Sudesh, Sujit K Tripathy

Citation Information : Gupta N, Sudesh P, Tripathy SK. Is Sonographic Calculation of Talonavicular Angle During Ponseti Correction of Clubfoot a Reliable Prognostic Indicator?. J Postgrad Med Edu Res 2012; 46 (4):190-195.

DOI: 10.5005/jp-journals-10028-1043

Published Online: 01-09-2014

Copyright Statement:  Copyright © 2012; The Author(s).



Ultrasonographic evaluation of clubfoot is an objective method of severity assessment. The objective of this article is to assess the reliability of clubfoot severity assessment by sonographic evaluation of talonavicular angle (TNA) and the reliability of assessing change in angle on simulated Ponseti manipulation.

Materials and methods

Twenty-six infants with unilateral idiopathic clubfoot, treated by serial manipulation and casting by Ponseti technique, were prospectively evaluated by clinical scoring (Dimeglio and Pirani scores) and sonographic measurements of TNA at the start of treatment, after midfoot correction and after complete correction achieved. The TNA and the change in TNA on simulated Ponseti manipulation were noted. Total number of POP casts required to achieve final correction were noted; and correlated with change in TNA on attempted Ponseti manipulation.


Mean TNA in clubfoot (66.46°) in static position was significantly different from that of contralateral normal foot (101.3°). Mean change in TNA on simulated Ponseti manipulation was 22.54° (5-50°) and it showed negative correlation with clinical scores and total number of casts required for final correction (p < 0.05). Linear regression analysis revealed that the change in TNA on simulated Ponseti manipulation was the best predictor of treatment outcome in congenital talips equinovarus (CTEV) (with predictability of 60% compared to 19 and 25% of Dimeglio score and Pirani score respectively).


Sonographic evaluation of TNA and change in TNA on simulated Ponseti manipulation can better assess the severity of clubfoot in infants. This objective method of assessment is less expensive, clinically applicable reproducible and it can better predict the treatment outcome.

How to cite this article

Gupta N, Sudesh P, Prakash M, Tripathy SK, Dhillon MS. Is Sonographic Calculation of Talonavicular Angle During Ponseti Correction of Clubfoot a Reliable Prognostic Indicator? J Postgrad Med Edu Res 2012;46(4):190-195.

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  1. Congenital talipes equinovarus in, Tachdjian pediatric orthopedics. WB Saunders 2008;4:2428-56.
  2. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. J Pediatrics Orthop 2004;113:376-80.
  3. Classification of clubfoot. J Pediatr Orthop B 1995;4:124-36.
  4. A method of assessing the virgin clubfoot. Paper presented at Peadiatric Orthpaedic Society of North America Orlando, USA May 1995.
  5. The ossific nucleus and the cartilage of the talus and calcaneum. J Bone and Joint Surg Br 1992;74:620-23.
  6. Onset of ossification of the tarsal bones in congenital clubfoot. J Pediatr Orthop 1997;17:36-40.
  7. MRI study of talonavicular alignment in clubfoot. J Bone Joint Surg Br 2001;83:726-30.
  8. Ultrasound anatomy in normal neonatal and infant foot: An anatomic introduction to ultrasound assessment of foot deformities. Eur Radiol 2002;12(9):2306-12.
  9. Ultrasound anatomy in neonatal clubfoot. Eur Radiol 2002;12(10):2509-17.
  10. Ultrasound of the navicular during simulated ponseti maneuver. J Peadiatr Orthop 2003;23:243-45.
  11. Age dependent dynamic sonographic measurement of pediatric clubfoot. Pediatr Radiol 2007;37:1125-29.
  12. Focused dynamic sonographic examination of congenital clubfoot. Pediatr Radiol 2007;37:1118-24.
  13. Ultrasound evaluation of clubfoot correction during Ponseti treatment. J Pediatr Orthop 2008;28:53-59.
  14. Congenital clubfoot (Editorial and annotations). J Bone Joint Surg Br 1964;46B:369-71.
  15. Long-term results of management of clubfoot. J Bone Joint Surg Am 1980;62:23-31.
  16. Treatment of idiopathic clubfoot. A 30 year follow-up. J Bone Joint Surg Am 1995;77:1477-78.
  17. Paper presented at the third Annual International Pediatric Orthopedic Seminar, Chicago, Illinois, USA; May 28, 1975.
  18. Significance of radiographic angle measurement in evaluation of congenital clubfoot. Arch Orthop Trauma Surg 1998;117:324-29.
  19. Treatment and prognosis in congenital clubfoot. J Bone Joint Surg 1983;65B:8-11.
  20. A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop B 2003;12:133-40.
  21. Sonographic assessment of clubfoot deformity in young children. J Pediatr Orthop B 1996;5:279-86.
  22. Sonographic classification of clubfoot according to severity. J Pediatr Orthop B 2006;15(2):134-40.
  23. The role of ultrasound in clubfoot treatment; correlation with the Pirani score and assessment of Ponseti method. Clin Orthop Relat Res 2010;468:2495-506.
  24. Congenital clubfoot—fundamentals of treatment. Oxford University Press, Oxford, England 1996:68.
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