A model for clubfoot based on micro-CT data.

The pathological anatomy of idiopathic clubfoot has been investigated for more than 180 years using anatomy, computed tomography (CT), histology and microscopy. Seven idiopathic clubfeet and two normal feet of aborted fetuses were dissected in the present study, with special emphasis on the shape of the cartilage and bones. A three-dimensional (3D) micro-CT system, which generates a series of X-ray attenuation measurements, was used to produce computed reconstructed 3D data sets of each of the separated bones. Based on the micro-CT data scans a high-definition 3D colour printing system was used to make a four times enlarged clubfoot model, precisely presenting all the bony malformations. This model reflects the complexity of the anatomy of this disease and is designed to be used in the workshops of orthopaedic surgeons and physiotherapists, for training in new surgical and manipulation techniques.

Anatomical study for an updated comprehension of clubfoot. Part II: Ligaments, tendons and muscles.

PURPOSE: The aim of our study was to evaluate the pathological anatomy of the ligaments, tendons and muscles in clubfeet, and to show whether the dysbalance of shortened and elongated structures is an adaptive process or a primary factor inducing the misshaped bones and cartilagines. METHODS: Surgical exposure was performed on seven idiopathic clubfeet specimens, aborted between the 25th and 37th week of gestation and compared to two normal feet (27th and 36th week of gestation). RESULTS: The medial stabilisation system of the foot was found shortened, but all ligaments could be dissected. On the lateral side, the calcaneofibular ligament in particular was both 'shortened' and 'elongated', depending on the course of the fibres to the axis of motion in the subtalar and talocalcaneonavicular joint. The main difference to the normal feet was found in the thickened tendon of the tibialis posterior forming a bulbus before dividing into fascicules. CONCLUSIONS: We presume the ossification disturbance of the calcaneus to be the primary fault. This disturbance will influence the reduction of the varus position, so ligaments and tendons will be conformed to the misshaped bones.

Anatomical study for an update comprehension of clubfoot. Part I: Bones and joints.

PURPOSE: The aim of our study was to elucidate the gross anatomical changes of bones and joints in idiopathic clubfeet. METHODS: Gross dissection was carried out on seven idiopathic clubfeet of fetuses aborted between the 25th and 37th week of gestation and compared to two normal feet (27th and 36th week of gestation). Particular attention was paid to the articular surfaces, shapes and angles of all bones and their skeletal relationships. RESULTS: The talar neck-trochlea angle in clubfeet ranged from 37 degrees to 41 degrees , in normal feet from 27 degrees to 33 degrees . In clubfeet the deviation of the neck of the talus relative to the body was between 28 degrees and 43 degrees , in normal feet between 22 degrees and 24 degrees . The posterior joint surface was in an anterolateral position and even flat transversely. The head of the clubfeet tali was turned along a longitudinal axis in the opposite direction compared to the normal ones. Instead of a typically saddle-shaped posterior talar surface of the calcaneus, it was triangular and flat transversely, and a bony stability in the subtalar joint was not achieved. The angle of torsion of the calcaneus showed no significant difference between normal and clubfeet. The anterior surface was flat, medially twisted and orientated upwards. CONCLUSIONS: We presume that the calcaneus is the primary fault, which might be explained by pathologic biomechanical forces during development.