SLR - December 2017 - Lauren E. Pruner
Quantification of the Ossification of the Lateral Cuneiform in the Feet of Young Children with Unilateral Congenital Talipes Equinovarus
Reference: Lang, P. J., Avoian, T., Sangiorgio, S. N., Nazif, M. A., Ebramzadeh, E., & Zionts, L. E. (2017). Quantification of the Ossification of the Lateral Cuneiform in the Feet of Young Children with Unilateral Congenital Talipes Equinovarus. Bone Joint J, 99-B(8), 1109–1114. Accessed October 29, 2017.
Scientific Literature Review
Reviewed By: Lauren E. Pruner, DPM
Residency: UPMC-Pinnacle Health System, Harrisburg, PA
Podiatric Relevance: This article considers lateral cuneiform size in TEV on the pediatric population of the podiatric field. The postoperative effect on the lateral cuneiform ossification center is a careful consideration that this article attempts to improve. The purpose of this study was to determine the age at which there is sufficient ossification of the lateral cuneiform in patients with CTEV to accommodate a tendon transfer to bone, should a TATT be necessary.
Methods: Inclusion criteria were patients treated for unilateral CTEV who had not undergone surgery and had at least three years' follow-up. All patients were between two and three years old upon entering study. Forty-three patients were consecutively measured for length, width and height of the lateral cuneiform on bilateral radiographs. This was measured at first visit and at three months prior to each patient’s birthday for a consecutive three years. Patients were divided into severity category 0 to 4, with 0 being mild and 4 being severe. Patients were also divided by how many casts were applied.
Results: On the three-year radiographs, the length and height of the lateral cuneiform in the affected feet remained significantly less than the corresponding dimensions of the unaffected feet (p < 0.001), while the width values were similar. Mean values of the length, width and height of the lateral cuneiform in affected feet increased from year 1 to 2 and from year 2 to 3. On the unaffected side, the mean values of the length, width, and height of the lateral cuneiform in affected feet increased from year 1 to 2, from year 2 to 3. Severity of deformity and dimension size did not show statistical significance, and this was related to population size of each severity class. Number of casts and size of cuneiform could not be considered to be clinically significant due to population size.
Conclusion: While the diameter of the tibialis anterior varies, a possible problem with earlier operative TATT is the tendon is too large to place in the lateral cuneiform, resulting in delayed bone healing. This article may not answer when to take TEV to the OR, but it does quantify the effect TEV has on the lateral cuneiform compared to a nonaffected contralateral side. The greatest difference in the size of the lateral cuneiform between affected feet and unaffected feet was found in the first year. At one year, there was no ossification of the lateral cuneiform in seven of the 43 affected feet. By two years, the ossification center of the lateral cuneiform in affected feet approached the size of that in unaffected feet. The most significant weakness was that not all patients were precisely the same age during the one-, two and three-year radiographs. The conclusion the authors made was the ossification center of the lateral cuneiform may not be sufficiently large to accommodate a tendon transfer before the age of three years.