Developing a three-dimensional (3D) assessment method for clubfoot

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Clubfoot is one of the most common complex foot deformities that affects 150,000 - 200,000 newborn babies annually around the world. This deformity is characterized by midfoot cavus, forefoot adductus, and hindfoot varus and equinus. Accurate evaluation of clubfoot is very essential to quantify the initial severity of clubfoot, choose the treatment options, and to monitor and predict prognosis However, a standardized assessment method for evaluating, quantifying, and grading the severity of the clubfoot is still controversial and lacking. Although there are a number of evaluation methods have been proposed to assess the severity of clubfoot, most of the assessment methods are too subjective. These assessment systems will not provide strongly objective measured clinical evidence. Imaging modalities such as magnetic resonance imaging (MRI), and computerized tomography (CT) scanning can be used to evaluate the initial severity of the clubfoot, but these techniques are too expensive for repeated use at each weekly casting session. Therefore, this research study aimed at 1) developing a novel 3D assessment method, (2) evaluating the thermophysiological changes after weekly casting, (3) developing a 3D evaluation method for bone to bone relationships in clubfoot, and (4) to investigate the effectiveness of Ponseti method under 2 years old children with clubfoot. A total of 4 children with clubfoot (2 males and 2 females) were recruited for this study. A Kinect scanner was used to collect 3D scan from the clubfoot (n=2; pre and post-casting intervention) and a normal foot (n=1). Infrared thermography (IR) camera was used to collect the thermal images of the clubfoot before and after the casting intervention. Moreover, clubfoot 3D model was developed from 2D slices of CT. This study results provided a new 3D objective assessment tool (3DAMC) to quantify the initial severity of the clubfoot. The measurement of pre and post casting intervention were compared, and the results showed the differences between pre and post intervention. In addition, the severe and corrected clubfoot were compared with normal foot and the results showed the all the angles of sixth week correction is closely reached to the range of normal foot cross section angles. In addition, the IR study results showed reduced temperature after the first casting and temperature difference between the weekly castings. This novel method can be used to observe thermal changes in the clubfoot between castings to avoid complications such as pressure ulcers, swelling, pressure sores and related complications and relapses.
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