Sonographic assessment of clubfoot

The main problem in patients with clubfoot is to identify the anatomical relationship of navicular to talus bone and of cuboid to calcaneous bone, both in the position of spontaneous alignment and of correction under passive manipulation, and the degree of dorsiflexion of the foot. The clinical examination is subjective and the radiological assessment is limited by incomplete ossification of tarsal bones. US have been recently used as complementary method to correct radiographic technique because able to identify the limitation of dorsiflexion and the improvement of movement gained during the conservative treatment. This is very important in deciding about the amount and the site of the surgical release. The foot has to be studied both in the position of spontaneous alignment and of correction under passive manipulation, using 7.5/10 MHz linear array probes. Using 3 standard US planes (sagittal-postenor, sagittal-anterior and coronal) the relationships of the talonavicular and calcaneocuboid joints must be focused, the range of dorsiflexion is documented measuring the distance between the tibial epiphysis and calcaneal apophysis and observing the posterior dislocation of the talus.