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J Child Orthop. 2012 Oct;6(5):433-8. doi: 10.1007/s11832-012-0444-9. Epub 2012 Oct 5.

An MRI volumetric study for leg muscles in congenital clubfoot.

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Department of Orthopaedic Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy.



To investigate both volume and length of the three muscle compartments of the normal and the affected leg in unilateral congenital clubfoot.


Volumetric magnetic resonance imaging (VMRI) of the anterior, lateral and postero-medial muscular compartments of both the normal and the clubfoot leg was obtained in three groups of seven patients each, whose mean age was, respectively, 4.8 months, 11.1 months and 4.7 years. At diagnosis, all the unilateral congenital clubfeet had a Pirani score ranging from 4.5 to 5.5 points, and all of them had been treated according to a strict Ponseti protocol. All the feet had percutaneous lengthening of the Achilles tendon.


A mean difference in both volume and length was found between the three muscular compartments of the leg, with the muscles of the clubfoot side being thinner and shorter than those of the normal side. The distal tendon of the tibialis anterior, peroneus longus and triceps surae (Achilles tendon) were longer than normal on the clubfoot side.


Our study shows that the three muscle compartments of the clubfoot leg are thinner and shorter than normal in the patients of the three groups. The difference in the musculature volume of the postero-medial compartment between the normal and the affected side increased nine-fold from age group 2 to 3, while the difference in length increased by 20 %, thus, showing that the muscles of the postero-medial compartment tend to grow in both thickness and length much less than the muscles of the other leg compartments.


Congenital clubfoot; Muscle atrophy; Muscle growth; Pathogenesis of congenital clubfoot; Volumetric MRI muscle study

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