Radiographic Assessment of Congenital Talipes Equinovarus: Strapping versus Forced Dorsiflexion

To the Editor: I read with interest the article by Yeung et al.1 Although clubfoot is a very common problem, researchers have still not reached a consensus on a reproducible description or assessment of the foot. The authors classified their patients’ conditions as severe clubfoot deformity according to the Dimeglio classification.2 Two methods were used to hold the feet for radiograph taking: strapping the ankle with tapes versus dorsiflexion with a wooden block. The authors were unable to measure the talocalcaneal angles on the anteroposterior radiographs using forced dorsiflexion. Figures 4b and 5b showing the feet being held flat against the X-ray plate are less likely to give goodquality radiographs. It is recommended that the tube be tilted cranially 30 degrees in order to see the rudimentary eccentric ossifying nuclei in cartilage enlarging these smal l feet . 3–5 The method recommended by Beatson and Pearsons5 for the measurement of talocalcaneal index was devised to outline the nuclear shadows of both talus and calcaneus. For anteroposterior view, the feet are held flat soles against the plate below, knees bent to 45 and X-ray tube tilted cranially 30. This shows both the nuclei crossing each other making the anterior talocalcaneal angle. For lateral view, the feet are Radiographic assessment of congenital talipes equinovarus: strapping versus forced dorsiflexion Authors’ reply We agree with the concern about refracture in the long term despite the initial solid clinical and radiographic union. Cases 1 and 2 were operated in August 2000 and July 2003, respectively, and solid union was achieved at 4 months; no refracture was observed despite no external protection at 5 and 3 years, respectively. Use of an intramedullary nail minimises the risk of refracture1,2 and we do not plan to remove the nails in both cases. The nail may have to be changed to a longer one to ensure prolonged and adequate internal splintage.1