genortГений ортопедииGenij Ortopedii1028-44272542-131XЦЕНТР ИЛИЗАРОВА10.18019/1028-4427-2025-31-6-756-763genort-3375Research ArticleОригинальные статьиOriginal articlesСтресс-рентгенография в оценке остаточной деформации идиопатической косолапости после серийного гипсования (метод Понсети) в провинции Thi-QarStress radiography in the assessment of residual deformity of idiopathic clubfoot following serial casting (Ponseti method) in Thi Qar provinceAbbasZ. А.AbbasZ. A.

Zain Ali Abbas

Zain Ali Abbas

AlBaghdadiF. A.AlBaghdadiF. A.

Firas Abdulla AlBaghdadi

Firas Abdulla AlBaghdadi

https://orcid.org/0000-0002-1267-3881ShatyW. G.ShatyW. G.

Wahby Ghalib Shaty — Assistant Professor (Orthopaedics)

Wahby Ghalib Shaty — Assistant Professor (Orthopaedics)

College of Medicine, University of Thi-QarИракCollege of Medicine, University of Thi-QarIraq202519122025316756763Copyright © Abbas Z.А., AlBaghdadi F.A., Shaty W.G., 20252025Abbas Z.А., AlBaghdadi F.A., Shaty W.G.Abbas Z.A., AlBaghdadi F.A., Shaty W.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ilizarov-journal.com/jour/article/view/3375

Введение. Косолапость, или врожденная эквиноварусная деформация стопы, является врожденным пороком развития стопы. Раннее выявление и идентификация могут обеспечить наилучшие долгосрочные результаты лечения для ребенка. Рентгенограммы с нагрузкой предоставляют объективные данные об остаточной деформации, определяя дальнейшее лечение.Цель работы — cравнение рентгенологических данных при остаточной идиопатической косолапости в положениях без нагрузки и с нагрузкой, а также определить взаимосвязь между разницей углов и видом лечения.Материал и методы. Данное исследование представляет собой сравнительное исследование, проведенное в клинической больнице Аль-Насирия. Данные были собраны за период с 1 марта 2024 года по 1 марта 2025 года. В исследовании приняли участие 73,3 % детей мужского пола, средний возраст которых составил 1,7 года. В исследование были включены 112 детей с деформацией косолапости и 45 детей с идиопатической косолапостью (54 стопы) с остаточной деформацией.Результаты. Нагрузочные рентгенограммы выявили значительное уменьшение углов при различных деформациях. Пороговые значения для угла между таранной и первыми плюсневыми костями в боковой проекции (аддукция) составили > 18°, а для угла между большеберцовой и пяточной костями (эквинус) — > 20°. Оба показателя характеризуются высокой чувствительностью и специфичностью.Дискуссия. Косолапость чаще встречается у пациентов мужского пола и часто проявляется односторонней деформацией. Наиболее распространенными остаточными деформациями являются эквинус и приведение.Заключение. Рентгенограммы под нагрузкой играют решающую роль, показывая значительные изменения углов, которые помогают оценить гибкость и тяжесть деформации. Более значительная разница углов коррелировала с успешным гипсованием, в то время как меньшая разница предсказывала необходимость хирургического вмешательства.

Background Clubfoot, or congenital talipes equinovarus, is a congenital foot malformation and condition. Its early detection and identification can ensure the best possible long-term outcomes for the infant. Stress radiographs provide objective evidence of residual deformity, guiding further treatment.Aim of the study was to compare radiographic findings of residual idiopathic clubfoot deformity in non-stress and stress positions to know the relationship of the angles difference and the type of treatment.Material and Methods This study is a cross-sectional comparative study conducted at Al-Nasiriyah Teaching Hospital. Data was collected for the period from the 1st of March 2024 to the 1st of March 2025. The study includes 73.3 % males in a mean age of 1.7 years. Unilateral deformities among them were 80 %, equinus 85.2 % and adduction 66.7 %. 112 children with clubfoot deformities and 45 with idiopathic clubfoot cases (54 feet) which had residual deformity were included.Results Stress radiographs revealed significant angular reductions in various deformities. Cutoffs of > 18° for the talo-first metatarsal angle in lateral view )adduction) and > 20° for the tibio-calcaneal angle (equinus), both with high sensitivity and specificity.Discussion Clubfoot is more prevalent in male patients and often presents as a unilateral deformity. The most common residual deformities observed are equinus and adduction.Conclusion Stress radiographs play a crucial role and show significant angular changes that help evaluate deformity flexibility and severity. Larger angle differences correlated with successful casting, while smaller differences predicted surgery.

стрессовая рентгенографияоценкаостаточная деформациякосолапостьсерийное гипсованиеstress radiographyassessmentresidual deformityclubfootserial castingReferencesBarrie A, Varacallo MA. Clubfoot. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publ.; 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK551574. Accessed Jun 19, 2025.Barrie A, Varacallo MA. Clubfoot. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publ.; 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK551574. Accessed Jun 19, 2025.Karol LA, Jeans KA. This is a narrative review of the functional evaluation of clubfoot treatment with gait analysis. Ann Transl Med. 2021;9(13):1105. doi: 10.21037/atm-20-6922.Karol LA, Jeans KA. This is a narrative review of the functional evaluation of clubfoot treatment with gait analysis. Ann Transl Med. 2021;9(13):1105. doi: 10.21037/atm-20-6922.Smythe T, Kuper H, Macleod D, et al. Birth prevalence of congenital talipes equinovarus in low- and middle-income countries: a systematic review and meta-analysis. Trop Med Int Health. 2017;22(3):269-285. doi: 10.1111/tmi.12833.Smythe T, Kuper H, Macleod D, et al. Birth prevalence of congenital talipes equinovarus in low- and middle-income countries: a systematic review and meta-analysis. Trop Med Int Health. 2017;22(3):269-285. doi: 10.1111/tmi.12833.Wallander H, Hovelius L, Michaelsson K. Incidence of congenital clubfoot in Sweden. Acta Orthop. 2006;77(6):847-852. doi: 10.1080/17453670610013123.Wallander H, Hovelius L, Michaelsson K. Incidence of congenital clubfoot in Sweden. Acta Orthop. 2006;77(6):847-852. doi: 10.1080/17453670610013123.Kruse LM, Buchan JG, Gurnett CA, Dobbs MB. Polygenic threshold model with sex dimorphism in adolescent idiopathic scoliosis: the Carter effect. J Bone Joint Surg Am. 2012;94(16):1485-1491. doi: 10.2106/JBJS.K.01450.Kruse LM, Buchan JG, Gurnett CA, Dobbs MB. Polygenic threshold model with sex dimorphism in adolescent idiopathic scoliosis: the Carter effect. J Bone Joint Surg Am. 2012;94(16):1485-1491. doi: 10.2106/JBJS.K.01450.Di Mascio D, Buca D, Khalil A, et al. Outcome of isolated fetal talipes: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2019;98(11):1367-1377. doi: 10.1111/aogs.13637.Di Mascio D, Buca D, Khalil A, et al. Outcome of isolated fetal talipes: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2019;98(11):1367-1377. doi: 10.1111/aogs.13637.Merrill LJ, Gurnett CA, Siegel M, et al. Vascular abnormalities correlate with decreased soft tissue volumes in idiopathic clubfoot. Clin Orthop Relat Res. 2011;469(5):1442-1449. doi: 10.1007/s11999-010-1657-1.Merrill LJ, Gurnett CA, Siegel M, et al. Vascular abnormalities correlate with decreased soft tissue volumes in idiopathic clubfoot. Clin Orthop Relat Res. 2011;469(5):1442-1449. doi: 10.1007/s11999-010-1657-1.Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Joint Surg Br. 2006;88(8):1082-1084. doi: 10.1302/0301-620X.88B8.17482.Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Joint Surg Br. 2006;88(8):1082-1084. doi: 10.1302/0301-620X.88B8.17482.Sambandam SN, Gul A. Stress radiography in the assessment of residual deformity in clubfoot following postero-medial soft tissue release. Int Orthop. 2006;30(3):210-214. doi: 10.1007/s00264-005-0057-8.Sambandam SN, Gul A. Stress radiography in the assessment of residual deformity in clubfoot following postero-medial soft tissue release. Int Orthop. 2006;30(3):210-214. doi: 10.1007/s00264-005-0057-8.Saleim AR, AlBaghdadi FA, Hasni I. The Accuracy of Radiographers Preliminary Image Evaluations of Axial Radiographs: a Prospective Longitudinal Study at Al-Hussein Hospital, Iraq. SEEJPH. 2024:695-702. doi: 10.70135/seejph.vi.1360.Saleim AR, AlBaghdadi FA, Hasni I. The Accuracy of Radiographers Preliminary Image Evaluations of Axial Radiographs: a Prospective Longitudinal Study at Al-Hussein Hospital, Iraq. SEEJPH. 2024:695-702. doi: 10.70135/seejph.vi.1360.Noh H, Park SS. Predictive factors for residual equinovarus deformity following Ponseti treatment and percutaneous Achilles tenotomy for idiopathic clubfoot: a retrospective review of 50 cases followed for median 2 years. Acta Orthop. 2013;84(2):213-217. doi: 10.3109/17453674.2013.784659.Noh H, Park SS. Predictive factors for residual equinovarus deformity following Ponseti treatment and percutaneous Achilles tenotomy for idiopathic clubfoot: a retrospective review of 50 cases followed for median 2 years. Acta Orthop. 2013;84(2):213-217. doi: 10.3109/17453674.2013.784659.Tayebi N, Yazdani K, Naghshin N. The prevalence of congenital malformations and its correlation with consanguineous marriages. Oman Med J. 2010;25(1):37-40. doi: 10.5001/omj.2010.9.Tayebi N, Yazdani K, Naghshin N. The prevalence of congenital malformations and its correlation with consanguineous marriages. Oman Med J. 2010;25(1):37-40. doi: 10.5001/omj.2010.9.Parsa A, Moghadam MH, Jamshidi MH. Relapsing and residual clubfoot deformities after the application of the ponseti method: a contemporary review. Arch Bone Jt Surg. 2014;2(1):7-10.Parsa A, Moghadam MH, Jamshidi MH. Relapsing and residual clubfoot deformities after the application of the ponseti method: a contemporary review. Arch Bone Jt Surg. 2014;2(1):7-10.Li J, Xun F, Xu C, et al. Early Radiographic Characteristics of the Lateral Talocalcaneal Angle and its Predictive Significance for Relapse in Patients With Idiopathic Clubfoot Treated With the Ponseti Method. J Foot Ankle Surg. 2024;63(6):646-652. doi: 10.1053/j.jfas.2024.05.009.Li J, Xun F, Xu C, et al. Early Radiographic Characteristics of the Lateral Talocalcaneal Angle and its Predictive Significance for Relapse in Patients With Idiopathic Clubfoot Treated With the Ponseti Method. J Foot Ankle Surg. 2024;63(6):646-652. doi: 10.1053/j.jfas.2024.05.009.Recordon JAF, Halanski MA, Boocock MG, et al. A Prospective, Median 15-Year Comparison of Ponseti Casting and Surgical Treatment of Clubfoot. J Bone Joint Surg Am. 2021;103(21):1986-1995. doi: 10.2106/JBJS.20.02014.Recordon JAF, Halanski MA, Boocock MG, et al. A Prospective, Median 15-Year Comparison of Ponseti Casting and Surgical Treatment of Clubfoot. J Bone Joint Surg Am. 2021;103(21):1986-1995. doi: 10.2106/JBJS.20.02014.Gunalan R, Mazelan A, Lee Y, Saw A. Pattern of Presentation and Outcome of Short-term Treatment for Idiopathic Clubfoot / CTEV with Ponseti Method. Malays Orthop J. 2016;10(3):21-25. doi: 10.5704/MOJ.1611.009.Gunalan R, Mazelan A, Lee Y, Saw A. Pattern of Presentation and Outcome of Short-term Treatment for Idiopathic Clubfoot / CTEV with Ponseti Method. Malays Orthop J. 2016;10(3):21-25. doi: 10.5704/MOJ.1611.009.Kappel A, Mortensen JF, Nielsen PT, et al. Reliability of stress radiography in the assessment of coronal laxity following total knee arthroplasty. Knee. 2020;27(1):221-228. doi: 10.1016/j.knee.2019.09.013.Kappel A, Mortensen JF, Nielsen PT, et al. Reliability of stress radiography in the assessment of coronal laxity following total knee arthroplasty. Knee. 2020;27(1):221-228. doi: 10.1016/j.knee.2019.09.013.Radler C, Manner HM, Suda R, et al. Radiographic evaluation of idiopathic clubfeet undergoing Ponseti treatment. J Bone Joint Surg Am. 2007;89(6):1177-11183. doi: 10.2106/JBJS.F.00438.Radler C, Manner HM, Suda R, et al. Radiographic evaluation of idiopathic clubfeet undergoing Ponseti treatment. J Bone Joint Surg Am. 2007;89(6):1177-11183. doi: 10.2106/JBJS.F.00438.

The authors declare that there are no conflicts of interest present.