4/15/2017 Bone&Joint

Username Password GO Register/Activate RSS

Forgot Username/Password? Log in through your Institution

Search... GO Advanced Search

Home Info for... Publications Education Multimedia Congress Mobile Specialty

Children's Orthopaedics: Further Opinion Leading research

and clinical practice
in orthopaedic

Neonatal foot deformities and their

surgery
Current Issue

relationship to developmental
Archive

dysplasia of the hip Sign up to Table of Contents alerts

Open access to the

RW Paton, Q Choudry best
musculoskeletal
J Bone Joint Surg [Br] 2009;91-B:655-8. science and
research
Current Issue
Archive
This prospective study of the relationship between neonatal foot deformities and associated developmental dislocation
Sign up to Table of Contents alerts
of the hip (DDH) is significant as it is a "dogma buster". The accepted teaching that all foot deformities are a risk factor
for associated DDH has been disproved by Paton and Choudry at least in the Blackburn district of the United
A global view in
Kingdom. The authors have convincingly shown that congenital talipes equinovarus (CTEV) is not associated with an orthopaedics
increased incidence of DDH, hence this common neonatal foot deformity is not a risk factor. They have recommended Current Issue
that such children no longer need to be subjected to screening for DDH and that in the UK Guidelines, the term "foot Archive

deformity" be redefined as "congenital talipes calcaneovalgus and metatarsus varus" in which a statistically significant
association with DDH was demonstrated.
Sign up to Table of Contents alerts
However, we must be careful that we don't "throw the baby's hip out with the bath water". The authors' data is very
relevant to the Blackburn district and the guidelines for DDH risk factors could safely be altered here as well as in the
entire UK if the Blackburn population can be shown to be a microcosm of the country. We must be cautious in applying
these results globally especially in areas where CTEV and/or DDH have a much higher incidence than in the Blackburn Follow@BoneJointPortal
district. In the Middle East for example where I am currently in practise, both CTEV and DDH have a very high incidence
and the association of both congenital conditions have been personally encountered anecdotally on several occasions.

As well we must remind ourselves that the authors excluded all neurological and syndromal conditions from their study
which often have associated CTEV and DDH e.g. arthrogryposis, spina bifida, or Larsen's syndrome. Since syndromes
are not always self evident, it would be a shame to miss a DDH in a child with a syndromic CTEV because a DDH screen
was not indicated by the "guidelines".

My approach to screening for DDH is simply to always examine the hips in any infant up to one year of age whether
they have a risk factor or not, i.e. the indication for a clinical hip screening is the mere presence of a hip!

We should all try to instil this clinical compulsion for DDH examination in all family practitioners and paediatricians.

Paton and Choudry have designed and completed an excellent longitudinal observational study that has challenged the
accepted dogma that all foot deformities are associated with a higher incidence of DDH. Their patience and
perseverance in bringing this 11 year study to a successful conclusion is commendable since we all know the many
pitfalls of longitudinal studies. In their environment, altering the guidelines to avoid sonographic studies of the hips in
neonates with CTEV is very reasonable. Those of us practising in areas of the world with a higher genetic predisposition
to either CTEV or DDH should avoid following suit until we have performed our own studies to clarify the risk/reward of
using sonography of the hips to detect DDH in children with congenital foot deformities.

Letts M

Dubai, United Arab Emirates

E-mail: mervandmarilyn@yahoo.com

Find us:
Copyright 2015 THE BRITISH EDITORIAL SOCIETY OF BONE & JOINT SURGERY All Rights Reserved. Registered charity no: 209299. Contact Us Help Terms Privacy Sitemap

http://www.boneandjoint.org.uk/content/furtheropinion/neonatalfootdeformitiesandtheirrelationshipdevelopmentaldysplasiahip 1/2
4/15/2017 Bone&Joint

http://www.boneandjoint.org.uk/content/furtheropinion/neonatalfootdeformitiesandtheirrelationshipdevelopmentaldysplasiahip 2/2