Tibiofibular torsion in congenital clubfoot

Tibiofibular torsion was measured by computed tomography in three series of patients affected by congenital clubfoot who were treated with different protocols. The normal leg of unilateral deformities served as the control. For the bilateral cases, only the right side was included in the study. The angle between the bicondylar axis of the tibia and the bimalleolar axis was the index of tibiofibular torsion. There were 34 clubfeet in the first series, treated with a posteromedial release, and 40 clubfeet in the second series, treated with a modified Ponseti method, whereas the third series included 16 clubfeet, treated with the original Ponseti method. All 90 clubfeet were graded at birth as group 3 according to the Manes classification. No patient had previous treatment. The patients of the first and the second series were followed up to maturity, whereas the patients of the third series were followed up to a maximum of 11 years of age. In the congenital clubfoot, the tibia and the fibula were externally rotated, in comparison with the normal leg; in fact, the average value of the angle of tibiofibular torsion was 32.2° in the first series, 23.9° in the second series, and 21.1° in the third series. In the normal tibiae, the average value of the angle of tibiofibular torsion was 21.4°. The difference between the first series and the normal controls was statistically significant, as was the difference between the first one and the other two series. The value of the tibiofibular torsion angle seems to be related to the manipulation technique used to treat clubfoot: when the manipulation does not allow a progressive eversion of the talus underneath the calcaneus, the external tibial torsion increases. At follow-up, an intoeing gait was present in seven treated clubfeet of the first series. In all of them except one, the highest value of the external tibial torsion angle was observed, with a low value of the Kite's angle and/or residual forefoot adduction. In the treated congenital clubfoot, persistent intoeing is not related to the angle of tibial torsion but rather to the amount of correction of calcaneal inversion and residual forefoot adduction.     

Reduced tibial torsion in congenital clubfoot: CT measurements in 24 patients

We determined leg torsion with CT scans through the femoral condyles and the ankle joints in 24 children (17 boys) with congenital clubfoot. In 16 cases, there was a bilateral clubfoot, in 5 cases it was left-sided and in 3 cases, it was on the right side. These children were compared to 17 healthy boys and 7 girls. The ages of all children ranged between 3 and 12 years.

The average external torsion of the leg in the patients with clubfoot was 20 (15) versus 31 (7) degrees in the healthy children (p = 0.002). This study shows that there are great variations in leg torsion in children with congenital clubfoot and, on average, the external torsion is significantly lower than in healthy subjects.     

Reduced tibial torsion in congenital clubfoot: CT measurements in 24 patients

We determined leg torsion with CT scans through the femoral condyles and the ankle joints in 24 children (17 boys) with congenital clubfoot. In 16 cases, there was a bilateral clubfoot, in 5 cases it was left-sided and in 3 cases, it was on the right side. These children were compared to 17 healthy boys and 7 girls. The ages of all children ranged between 3 and 12 years. The average external torsion of the leg in the patients with clubfoot was 20 (15) versus 31 (7) degrees in the healthy children (p = 0.002). This study shows that there are great variations in leg torsion in children with congenital clubfoot and, on average, the external torsion is significantly lower than in healthy subjects.     

Tibiofibular torsion in normal and treated clubfoot populations

Tibiofibular torsion was measured in normal and clubfoot populations. A gradual increase, up to skeletal maturity, was demonstrated in normal legs. Lateral tibiofibular torsion was reduced in patients at the completion of clubfoot treatment, and it was concluded that derotation braces did not influence this result.     

Tibial torsion measured in normal adults

A mobile fluoroscope was used to measure tibial torsion bilaterally in a random sample of 100 adults without a medical history of injury to the lower extremities. From a chosen neutral position, the difference in torsion between the right and the left tibia in the same subject ranged from -11 to 15°, with a mean value of + 2.1°, indicating greater outward rotation of the right tibia in two thirds of the subjects. A difference in torsion of more than 6° was found in a fourth of the subjects.     

Tibial torsion measured in normal adults

A mobile fluoroscope was used to measure tibial torsion bilaterally in a random sample of 100 adults without a medical history of injury to the lower extremities. From a chosen neutral position, the difference in torsion between the right and the left tibia in the same subject ranged from -11 to 15 degrees, with a mean value of +2.1 degrees, indicating greater outward rotation of the right tibia in two thirds of the subjects. A difference in torsion of more than 6 degrees was found in a fourth of the subjects.     

Incidence of congenital clubfoot in Sweden

Background?Idiopathic clubfoot is one of the most common congenital orthopedic problems. Nationwide studies of the incidence are scarce. We performed a prospective multicenter study in order to assess the cumulative incidence in Sweden over 2 consecutive years.

Patients and methods?44 clinics identified as treating clubfoot reported new cases prospectively. The medical records of 280 children with clubfoot born during 1995– 1996 were collected and analyzed with special reference to gender, regional distribution and seasonal variation.

Results?The average cumulative incidence of clubfoot during the study period was 1.4/10³ (95% CI 1.2– 1.6). Three-quarters of the cases were boys. In half of the cases both feet were affected. There was significant regional heterogeneity, but no seasonal variation in occurrence of clubfoot.

Interpretation?The cumulative incidence was higher than in earlier Scandinavian studies. Gender distribution and laterality were similar to those in previous reports. We found significant regional differences in incidence, but the cause of this observation must be investigated in greater depth.     

Incidence of congenital clubfoot in Sweden

Background Idiopathic clubfoot is one of the most common congenital orthopedic problems. Nationwide studies of the incidence are scarce. We performed a prospective multicenter study in order to assess the cumulative incidence in Sweden over 2 consecutive years.

Patients and methods 44 clinics identified as treating clubfoot reported new cases prospectively. The medical records of 280 children with clubfoot born during 1995- 1996 were collected and analyzed with special reference to gender, regional distribution and seasonal variation.

Results The average cumulative incidence of clubfoot during the study period was 1.4/10³ (95% CI 1.2- 1.6). Three-quarters of the cases were boys. In half of the cases both feet were affected. There was significant regional heterogeneity, but no seasonal variation in occurrence of clubfoot.

Interpretation The cumulative incidence was higher than in earlier Scandinavian studies. Gender distribution and laterality were similar to those in previous reports. We found significant regional differences in incidence, but the cause of this observation must be investigated in greater depth.