Hyperextension of the big toe at metatarsophalangeal joint [MTPJ]: a sign of the undercorrection of cavus in idiopathic clubfoot in Ponseti method

ABSTRACT

Hyperextension of the big toe is described here as a simple and reliable sign to predict undercorrection of cavus deformity of clubfoot in the Ponseti Method. This retrospective study was conducted on children with clubfoot who were treated successfully by Ponseti Method in the King Fahad Hospital, Saudi Arabia, and Emam Reza Hospital, Mashad, Iran, from 2003 through 2008. The total number of the patients in our study was 191, with 306 affected feet. Of them, 115 children had bilateral clubfeet [230 feet] and 76 had unilateral clubfoot. There were 119 males and 72 females. Hyperextension of the big toe at MTPJ was present in five cases of clubfoot. The average follow-up period was 20 months [range 8-38 months]. The authors observed that hyperextension of bit toe at MTPJ had a linear relationship with the severity of cavus deformity of clubfoot. One the other hand, the big toe had a normal relationship with other toes after satisfactory treatment of the initial or relapsed cavus deformity by Ponseti Method. Hyperextension of the big toe at MTPJ can be regarded as a reliable prognostic sign for detecting the severity, correction, and the number of castings needed for cavus deformity correction in clubfoot treatment in the Ponseti Method: