Observational Study on Impact of Pediatric Foot Pathology and its Management in Ossification of Midfoot Tarsal bones

As Julius Wolff in 1868 stated that every change in the form or function of a bone is followed by adaptive changes in its internal architecture and its external shape, we conducted an observational study radiologically in the children attending our hospital to note the trend in the ossification of the midfoot tarsal bones in normal and in pathological conditions and determine the impact that each disease levies on the bone re-modelling
and maturation. We studied the ossification status of 402 foot with a sex ratio of M: F 2.86:1. The mean age of the children enrolled in the study is 50.23 months (range 0.3-144). There was equal distribution of the side of the foot studied. The pathological distribution of the foot was as follows: 278 Club Foot, 88 Normal Foot, 16 Congenital Vertical Talus, 8 Flat foot, 4 Coalition of tarsal bones, 4 Cerebral Palsy, 4 Hereditary
Sensory and Autonomic Neuropathy. We compared the rate of ossification of pathological foot with the normal foot. Out of the 278 club foot involved in the study 20 underwent Tibialis Anterior Tendon Transfer (TATT) for residual deformity following Ponsetti correction. We found that there is a significant delay in the ossification of the medial midfoot tarsal bones like intermediate and medial cuneiform and navicular in club
foot cases. Intervention in the form of Ponsetti casting and tendon transfer significantly altered the rate of ossification of the tarsal bones. This establishes the pathology involved in the disease like club foot which results in the varus positioning of the foot in children resulting in faster ossification of the lateral midfoot tarsal bones and significant delay in the ossification of the medial midfoot tarsal bones comparing to the normal population of same age. By procedures like Ponsetti and TATT which normalises the weight bearing of all the midfoot tarsal bones resulted in a significant change in the rate of ossification of the midfoot tarsal bones compared to the untreated patients of same age. Keywords:Foot Ossification, Club Foot, TATT, Ponsetti casting