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The Prognostic value of Radiological Appearance of the Ossific Nucleus of the Navicular in club feet

Dr. Alaa Azmi Ahmad- Ramallah , PalestineDr. Norman Otsuka Shriner Hospital - Los Angeles - USA. . . Club foot is a congenital deformity consisting of hind foot equinus , hind foot and forefoot varus and Supination of the forefoot . . . . It is a complex deformity involving talus, navicu

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The Prognostic value of Radiological Appearance of the Ossific Nucleus of the Navicular in club feet

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    1. The Prognostic value of Radiological Appearance of the Ossific Nucleus of the Navicular in club feet

    2. Dr. Alaa Azmi Ahmad- Ramallah , Palestine Dr. Norman Otsuka Shriner Hospital - Los Angeles - USA

    3. Club foot is a congenital deformity consisting of hind foot equinus , hind foot and forefoot varus and Supination of the forefoot .

    4. It is a complex deformity involving talus, navicular, calcaneus , cuboid and related joints with soft tissue structures.

    5. plain X-ray is the most dependable radiological examination for diagnosis and prognosis of club feet..

    6. Ossific nucleus of the navicular usually appears between 3-5 years of age.

    7. In this study we retrospectively evaluated X rays of 41 club feet

    8. These feet were all treated surgically for the first time by soft tissue release.

    9. We evaluated the relationship of the appearance of navicular with the prognosis of surgery

    10. Methods

    11. Records of X ray were reviewed of 41 club feet with no associated congenital or neuromuscular disorder who underwent soft tissue release as a primary surgical treatment. all patients were treated in hospital between 1993-1998 with mean follow up of 5.9 years.

    12. There were 24 feet with a normal shaped navicular, 17 feet with abnormal shaped navicular. X rays were evaluated pre-op. , post-op. and at the time of the most recent follow up visit.

    13. Measurements were done for

    14. Talo calcaneal angle

    15. Space between articular surface of talus and cuniformis

    16. Level of dorsal subluxation of navicular.

    17. Length of navicular bone

    18. Results

    19. Age By years

    20. Radiological follow up by years

    21. Relapsed club foot

    22. Post-op. infection

    23. Decreased distance between talus and cuniformis

    24. Results

    25. Conclusion

    26. Results show that avascular necrosis of naviscular has no prognostic value in accordance with the clubfoot relapse. Results show that increased incidence of avascular necrosis is related to decreased distance between articular surface of talus and cuniformis.

    27. results show that increased incidence of avascular necrosis is related to age of the patient at the time of surgery i.e if the patient is less that year of age .

    28. significance

    29. Avascular necrosis of navicular has no prognostic value in club foot post surgery. To avoid avascular necrosis, it is preferable that surgery is to be done of after 1 year of age. Try not to compress the navicular between talus and cuniformis during surgery

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