Congenital isolated clubfoot: Correlation between prenatal assessment and postnatal degree of severity

• Published in: Prenatal diagnosis Vol. 40; no. 12; pp. 1547 - 1552
• Main Authors: Lanna, Mariano, Casati, Daniela, Torre, Clelia, Monforte, Sergio, Andreacchio, Antonio, Faiola, Stefano, Cetin, Irene, Rustico, MariaAngela
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-12-2020; Wiley Subscription Services, Inc
• Subjects: Clubfoot; Correlation analysis; Diagnosis; Diagnostic systems; Dimensional analysis; Feet; Fetuses; Foot diseases; Leg; Neonates; Prenatal diagnosis; Tibia
• ISSN: 0197-3851; 1097-0223
• DOI: 10.1002/pd.5808

Objective
Since prenatal diagnosis of isolated clubfoot has a false positive rate (FP) of 10%‐40%, fetal parameters that might correlate with post‐natal confirmation and grade of severity were investigated.
Method
Retrospective analysis (2013‐2019) of cases analysed with three‐dimensional multiplanar view. The following data were recorded: the angle between the long axis of foot and lower leg; width, length and width‐to‐length ratio (W/L) of the foot; tibia length and calf width (T/C) ratio. Severity after birth was assessed using the Pirani classification.
Results
Diagnosis was confirmed in 45/53 neonates (84.9%, FP 15%). Values were higher for both angle and W/L in true vs false positive cases (median angle 100.4° versus 69.55°, p <.000; median W/L 0.53 vs 0.45, p = .001), no difference for T/C (3.77 vs 3.48, p = .8). The area under the curve for angle was 0.98 (CI 0.94‐1.00), with a diagnostic cut‐off of 84.7° (PPV of 100%, NPV of 66.7%). Median Pirani score, available for 33 neonates (73.3%) was 3 (IQR 3‐4): only angle correlated with Pirani score (Spearman coefficient 0.36, p = .04)
Conclusion
Measuring the angle between the foot and lower leg can reduce the FP rate of prenatal congenital clubfoot diagnosis and better predict the need for postnatal treatment.