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Radiographic Assessment of Club Foot

- Discussion:
    - helps to determine preoperative pathology;
    - in infancy, ossification centers of the talus, calcaneus, and cuboid are present, whereas the navicular does not appear until 3-4 yr;

- Method of Beatson and Pearson
    - AP of Foot:
          - taken in 30 deg plantarflexion, with the x-ray tube directed 30 deg from the perpendicular;
          - lines are drawn longitudinally thru the talus parallel to its medial border and thru the calcaneus parallel to its lateral border;
           - on AP view, talocalcaneal angle should be between 25-40 deg;
                - angle more than 35 deg indicates valgus;
                - angle less than 20 deg indicates varus;
    - Lateral of Foot:
           - taken with the foot in 30 deg of flexion;
           - x-ray beam should be perpendicular to both malleoli;
           - lines are drawn longitudinally thru the central axis of talus and parallel to the lower border of the body of the calcaneus;
           - parallelism of the calcaneus and talus is key;
           - this is recognized as a decr in lateral talocalcaneal angle which is normally 30-50 deg;
           - this does not increase on max dorsiflexion view;
           - on lateral view, this angle should be between 35 - 40 deg;
    - Forced dorsiflexion lateral:
           - will show an angle smaller than nl (35-50 deg);
           - w/ club foot, axes of talus & calcaneus becomes more parallel;
           - most reliable roentgenographic view is the lateral projection, usually with the foot in maximum dorsiflexion.
           - in clubfoot there is no convergence of talocalcaneal region (parallel alignment), and the tibiocalcaneal relationship reveals equinus;
           - plantar flexion at the ankle (equinus)
           - forefoot and hindfoot inversion (varus);

    - Kyte's angles from AP and Lateral views are added together to form talcalcaneal index;
           - in a corrected foot the talocalcaneal index should be greater than 40 degrees

A Method of Assessing Correction in Club Feet.

Deformity of the calcaneocuboid joint in patients who have talipes equinovarus.

A standardized method for the radiographic evaluation of cludfeet.

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