1 - Serviço de Radiologia, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa;
2 - Serviço de Radiologia, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa;
3 - Serviço de Radiologia, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa;
- Publicação sob a forma de poster electrónico no International Pediatric Radiology Congress 2021 (11/10/2021-15/10/2021)
Resumo:
Introduction and objectives: Description of the techniques used in the radiological assessment of congenital talipes equinovarus, the morphological alterations found in the initial assessment of this deformity and the main findings in its long-term post-therapeutic assessment.
Materials and methods: Bibliographical research, review, and selection of the most relevant articles about radiological assessment of the deformity in talipes equinovarus. Selection of original sample images of radiological studies of patients with talipes equinovarus treated in a pediatric university hospital.
Results: The deformity in talipes equinovarus (also known as clubfoot) is the most common musculoskeletal congenital defect and affects up to 5% of live births. It courses with several morphological alterations related to muscle contractures, including an abnormally high plantar longitudinal arch (pes cavus), an unnatural adduction and inversion of the forefoot (pes varus) and an inability to dorsiflex the ankle (pes equinus). It is associated with countless skeletal dysplasias and syndromic conditions. The severity of the deformity is highly variable, from an almost normal foot to an extremely complex clubfoot. The radiological assessment starts with dorsoplantar and lateral radiographs of the foot in a standing position, if possible, to characterise the talocalcaneal and the talus-first metatarsal angles, as well as to exclude associated bony anomalies. The main therapeutic options are nonoperative, including the Ponseti method, with serial manipulation and casting. The presence of associated lesions and the failure of conservative treatment are indications for surgical therapy, with tendon lengthening, lengthening or shortening osteotomies and soft tissues release. The post-therapeutic imaging assessment aims to evaluate the outcomes and exclude complications from these procedures. Common post-therapeutic complications include over- or under-correction, loss of stability of the tibiotarsal joint and talus osteonecrosis, which must be actively searched during imaging evaluation.
Conclusions: The radiological assessment of deformities in talipes equinovarus plays a complementary role in the initial characterisation and long-term assessment of this entity. The radiologist must know the alterations belonging to this deformity, the frequently associated anomalies and the characteristics of the main therapeutic interventions used in its correction.
Palavras Chave: Congénito, Equinovarus, Músculo-esquelético, Pediatria, Radiologia