1958

First results of ultrasound imaging of clubfoot come from 63 years ago. 1958 was a key year for the first discoveries in this direction. Technological progress and the dynamically developing knowledge of the defect lead from timid attempts to describe the image seen to more and more bold analyzes. Over the years, ultrasound diagnostics has developed significantly, reducing the risk of an error. It does not change the fact that, many things cannot be perfectly explained and clarified and that this branch of medicine is still improving. Including the diagnosis of clubfoot.

WHEN?

Congenital clubfoot develops after 12 weeks of pregnancy, so it is difficult to see the defect earlier. What’s more – it may not be visible at all, even in the later stages of pregnancy. Most often, however, it is diagnosed between 16 and 23 weeks of gestation. Most of the defects are detected between 18 and 22 weeks of pregnancy. The knowledge, skills and experience of the doctor performing the examination and the quality of the equipment (the sensitivity of the probes is very important) are of great importance in detecting it, which allows not only simple imaging, but also the possibility of 3D and 4D imaging. The gestational age also affects the result. Transvaginal ultrasound gives better diagnostic results in the earlier weeks of pregnancy (14-16 weeks of pregnancy), and transabdominal ultrasound gives better results after 16 weeks of pregnancy.

EXPERIENCE

Regardless of which type of examination you choose – 2D, 3D, 4D – you must be aware that not every doctor can handle the diagnosis. Each gynecologist performs a basic examination (preliminary anatomical assessment of the basic elements), but good prenatal diagnostics requires an experienced doctor who specializes in this type of diagnosis. It happens that ultrasound examination in the field of gynecology is performed by radiologists, and if everything is fine and the pregnancy proceeds smoothly, it is not a major problem, but it should definitely be performed by a gynecologist specializing in radiology. It should also be remembered that even an experienced doctor may not notice a defect during the examination. You cannot blame him for “not seeing”, because correct diagnosis depends not only on his skills and equipment, but also on the positioning of the child, which cannot be turned so easily. .

TWO, THREE, FOUR

In general, clubfoot can be diagnosed during a routine 2D examination. If it is suspected that your child may have a defect, using 3D (three-dimensional) or even 4D (four-dimensional) imaging will undoubtedly be an advantage (not a necessary condition for diagnosis, but highly helpful). During 3D (three-dimensional) ultrasound, the child is visible on the monitor screen as a three-dimensional (placed in space), stationary body. Thanks to the three dimensions, it is much easier for a doctor to see the fetus from the outside, and therefore the feet can also be viewed, measured, if possible (depending on the child’s position). 4D (four-dimensional) ultrasound allows you to see a child in motion in a specific three-dimensional space, dynamically, which may translate into an even better diagnosis of the defect. Clubfoot is clearly visible during movement and in most cases leaves no illusions.

ULTIMATELY!

The increasing possibilities of equipment and advanced research into prenatal diagnostics enable a more accurate diagnosis of the defect. 60% of clubfoot are diagnosed during USS. Thanks to the scales. that are developed by doctors around the world, it is possible to determine the type of feet: typical and atypical, the degree of deformation and prognosis for further treatment, especially when clubfoot is the result of other, much more serious defects. However, all of this is under development and is not widely accepted. It also has many limitations. The prenatal diagnosis of clubfoot continues to struggle with many questions that doctors are looking for answers and solutions to. The conclusion is that diagnosis will finally be confirmed only after delivery. This means that on the basis of ultrasound examination, the doctor is not able to determine whether the feet are actually clubfoot or whether it is a positional defect, whether they are “standard” or atypical. It is also difficult to correlate the “degree” of the defect diagnosed during ultrasound with the actual image after delivery, because it is often not determined and recorded.

SOMETHING MORE?

Congenital clubfoot is often a RESULT or companion of other defects and syndromes. Thus, if a foot defect is detected in the examination, it is the doctor’s duty to examine the child carefully and take more precise measurements of the relevant parameters. Of course, they are not always reliable. If it turns out that clubfoot is the result of something more serious, e.g. Down’s syndrome, it is advisable to do some additional tests, e.g. PAPP test, NIFTY test, karyotype or amniocentesis. A detailed family history is also the basis for a good diagnosis of any defects. Some of these tests are invasive and carry a risk of miscarriage – be aware of this. In most cases, the defect is idiopathic, which means that the cause is unknown. In this case, performing additional tests is not necessary and even debatable.

DISPUTES

RELABILITY

Prenatal diagnosis of clubfoot is helpful in postnatal treatment planning but should be as accurate as possible: misdiagnosis can cause excessive stress to parents and can lead to unnecessary invasive testing. Conversely, well-performed diagnosis can ease parental anxiety, rule out invasive testing, and help parents understand the defect and prepare for better treatment. The ability to properly advise patients requires a physician to carefully diagnose both the deformity of the foot itself and any other related abnormalities.