Volume 6 | Issue 1 | Jan – April 2020 | Page: 7-10 | B. Pasupathy, M. Sathish
Authors : B. Pasupathy , M. Sathish 
 Department of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai, TamilNadu India.
Address of Correspondence
Institute of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai Tamil Nadu India.
As Julius Wolff in 1868 stated that every change in the form or function of a bone is followed by adaptive changes in its internal architecture and its external shape, we conducted an observational study radiologically in the children attending our hospital to note the trend in the ossification of the midfoot tarsal bones in normal and in pathological conditions and determine the impact that each disease levies on the bone re-modelling and maturation. We studied the ossification status of 402 foot with a sex ratio of M: F 2.86:1. The mean age of the children enrolled in the study is 50.23 months (range 0.3-144). There was equal distribution of the side of the foot studied. The pathological distribution of the foot was as follows: 278 Club Foot, 88 Normal Foot, 16 Congenital Vertical Talus, 8 Flat foot, 4 Coalition of tarsal bones, 4 Cerebral Palsy, 4 Hereditary Sensory and Autonomic Neuropathy. We compared the rate of ossification of pathological foot with the normal foot. Out of the 278 club foot involved in the study 20 underwent Tibialis Anterior Tendon Transfer (TATT) for residual deformity following Ponsetti correction. We found that there is a significant delay in the ossification of the medial midfoot tarsal bones like intermediate and medial cuneiform and navicular in club foot cases. Intervention in the form of Ponsetti casting and tendon transfer significantly altered the rate of ossification of the tarsal bones. This establishes the pathology involved in the disease like club foot which results in the varus positioning of the foot in children resulting in faster ossification of the lateral midfoot tarsal bones and significant delay in the ossification of the medial midfoot tarsal bones comparing to the normal population of same age. By procedures like Ponsetti and TATT which normalises the weight bearing of all the midfoot tarsal bones resulted in a significant change in the rate of ossification of the midfoot tarsal bones compared to the untreated patients of same age.
Keywords: Foot Ossification, Club Foot, TATT, Ponsetti casting.
1. Richard D, Wayne VA, Adam WM. Gray’s Anatomy for Students E-Book. London: Churchill Livingstone; 2009.
2. Baker B, Dupras T, Tocheri M. Third or lateral cuneiform. In: The Osteology of Infants and Children. Texas: A& M University Press; 2005. p. 145.
3. Erasmie U, Ringertz H. A method for assessment of skeletal maturity in children below one year of age. PediatrRadiol 1980;9:225-8.
4. Zionts LE, Jew MH, Ebramzadeh E, Sangiorgio SN. The Influence of sex and laterality on clubfoot severity. J PediatrOrthop 2017;37:129-33.
5. Kuo KN, Hennigan SP, Hastings ME. Anterior tibial tendon transfer in residual dynamic clubfoot deformity. J PediatrOrthop2001;21:35-41.
6. Ponseti IV. Relapsing clubfoot: Causes, prevention, and treatment. Iowa Orthop J 2002;22:55-6.
7. Dietz FR.Treatment of a recurrent clubfoot deformity after initial correction with the Ponseti technique. Instruct Course Lect 2006;55:625-9.
8. Ezra E, Hayek S, Gilai AN, Khermosh O, Wientroub S.Tibialis anterior tendon transfer for residual dynamic supination deformity in treated club feet. J PediatrOrthop B 2000;9:207-11.
9. Holt JB, Oji DE, Yack HJ, Morcuende JA. Long-term results of tibialis anterior tendon transfer for relapsed idiopathic clubfoot treated with the ponseti method: A follow-up of thirty-seven to fifty-five years. J Bone Joint Surg Am 2015;97:47-55.
10. Farsetti P, Caterini R, Mancini F, Potenza V, Ippolito E. Anterior tibial tendon transfer in relapsing congenital clubfoot: Long-term follow-up study of two series treated with a different protocol. J PediatrOrthop 2006;26:83-90
11. Feldbrin Z, Gilai AN, Ezra E, Khermosh O, Kramer U, Wientroub S. Muscle imbalance in the aetiology of idiopathic club foot. An electromyographic study. J Bone Joint Surg Br 1995;77:596-601.
12. Thometz J, Sathoff L, Liu XC, Jacobson R, Tassone JC. Electromyography nerve conduction velocity evaluation of children with clubfeet. Am J Orthop (Belle Mead NJ) 2011;40:84-6.
13. Tokarowski A, Papiez M, Czop T. Electric excitability of the peroneal muscles in congenital equinovarus deformity. ChirNarzadowRuchuOrtop Pol 1989;54:59-62.
14. Miyagi N, Iisaka H, Yasuda K, Kaneda K. Onset of ossification of the tarsal bones in congenital clubfoot. J PediatrOrthop 1997;17:36-40.
|How to Cite this Article: Pasupathy B, Sathish M.| Observational Study on Impact of Pediatric Foot Pathology and its Management in Ossification of Midfoot Tarsal bones.| International Journal of Paediatric Orthopaedics | Jan-April 2020; 6(1): 7-10.|