Lateral Cuneiform Ossification and Tibialis Anterior Tendon Width in Children Ages 3 to 6: Implications for Interference Screw Fixation of Tibialis Anterior Tendon Transfers in Children.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors declare no conflicts of interest. 6. J Pediatr Orthop. 2022 May-Jun 01;42(5):e459-e465. doi: 10.1097/BPO.0000000000002119. Dynamic Supination in Congenital Clubfoot: A Modified Delphi Panel Approach to Standardizing Definitions and Indications for Treatment. Baskar D(1), Hosseinzadeh P(2), Mosca V(3), Bouchard M(4), Aroojis A(5), Arkader A(6), Cidambi E(7), Denning J(8), Eastwood D(9), Gantsoudes G(10), Kelly DM(11), Kishta W(12), Masquijo J(13), May C(14), Milbrandt T(15), Nichols LR(16), Frick S(1). Author information: (1)Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA. (2)Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO. (3)Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA. (4)Division of Orthopedics, Hospital for Sick Children, Toronto. (5)Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra, India. (6)The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA. (7)Department of Orthopaedic Surgery, Rady Children's Hospital-San Diego, University of California San Diego School of Medicine, San Diego, CA. (8)Division of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH. (9)Department of Paediatric Orthopaedics, Great Ormond Street Hospital for Children and University College London, London, UK. (10)Department of Orthopedics, Inova Fairfax Hospital, Fairfax, VA. (11)Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Le Bonheur Children's, Memphis, TN. (12)Division of Orthopaedics, Faculty of Health Sciences, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. (13)Department of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, Argentina. (14)Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA. (15)Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN. (16)Department of Orthopedic Surgery, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE. BACKGROUND: Dynamic supination is a well-recognized cause of congenital clubfoot deformity relapse. However, there is no consensus on how to diagnose it and there are varied approaches in its management. This study aims to define dynamic supination and indications for treatment by presenting consensus from an international panel of experts using a modified Delphi panel approach. METHODS: An international panel of 15 pediatric orthopaedic surgeons with clinical and research expertise in childhood foot disorders participated in a modified Delphi panel on dynamic supination in congenital clubfoot. Panelists voted on 51 statements using a 4-point Likert scale on dynamic supination, clinical indications for treatment, operative techniques, and postoperative casting and bracing. All panelists participated in 2 voting rounds with an interim meeting for discussion. Responses were classified as unanimous consensus (100%), consensus (80% or above), near-consensus (70% to 79%), and indeterminate (69% or less). RESULTS: Consensus was achieved for 34 of 51 statements. Panelists agreed dynamic supination is present when the forefoot is supinated during swing phase of gait with initial contact on the lateral border of the foot. There was also agreement that dynamic supination results from muscle imbalance between the tibialis anterior and the peroneus longus and brevis. There was no consensus on observation of hindfoot varus in dynamic supination, operative indications for posterior release of the ankle joint, or incisional approach for tibialis anterior tendon transfer. Reference to the calcaneopedal unit concept, planes of movement, and phases of gait were deemed important factors for consideration when evaluating dynamic supination. CONCLUSIONS: Consensus statements from the Delphi panel can guide diagnosis and treatment of dynamic supination in clubfoot deformity relapse, including clinical decision making regarding preoperative casting, surgical approach, and postoperative immobilization. Near-consensus and indeterminate statements may be used to direct future areas of investigation. LEVEL OF EVIDENCE: Level V. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BPO.0000000000002119