Dynamic real time ultrasound of the clubfoot and ankle joint

Clubfoot is one of the most common congenital deformities (1 to 6/1000). Clubfoot is a complex 3D deformity. The foot is in equino-varus-adductus position due to stiffness of soft tissues at the medial and posterior aspect of the lower leg and foot. Ultrasound helps visualizing movement in the ankle joint realtime and calcaneus position. To standardize ultrasound (reproducibility) the posterior border of the talocalcaneal joint (neutral position+dorsiflexion) and the cartilaginous surface of the calcaneus (plantar flexion) were chosen by Johansson et al (2018) measuring distance to the distal tibial physis. The posterior tibia border of the physis was chosen because it's not hidden by ossified bone in older children and can be easily identified, even at the age of four years. The authors concluded that ultrasounf of posterior aspect of the ankle joint can be done with high interexaminer reliability, repeatability of image evaluation was high, correlation to clinical measurements varied. Dynamic real-time ultrasound is clinically more useful than single measurements on frozen ultrasound images. Dynamic ultrasound of ankle joint can be a valuable tool in education and follow-up in case of doubt about the movement in the ankle joint during the first four years of life.