Stress radiography in the assessment of residual deformity of idiopathic clubfoot following serial casting (Ponseti method) in Thi Qar province

Background Clubfoot, or congenital talipes equinovarus, is a congenital foot malformation and condition. Its early detection and identification can ensure the best possible long-term outcomes for the infant. Stress radiographs provide objective evidence of residual deformity, guiding further treatment. Aim of the study was to compare radiographic findings of residual idiopathic clubfoot deformity in non-stress and stress positions to know the relationship of the angles difference and the type of treatment. Material and Methods This study is a cross-sectional comparative study conducted at Al-Nasiriyah Teaching Hospital. Data was collected for the period from the 1st of March 2024 to the 1st of March 2025. The study includes 73.3 % males in a mean age of 1.7 years. Unilateral deformities among them were 80 %, equinus 85.2 % and adduction 66.7 %. 112 children with clubfoot deformities and 45 with idiopathic clubfoot cases (54 feet) which had residual deformity were included. Results Stress radiographs revealed significant angular reductions in various deformities. Cutoffs of > 18° for the talo-first metatarsal angle in lateral view )adduction) and > 20° for the tibio-calcaneal angle (equinus), both with high sensitivity and specificity. Discussion Clubfoot is more prevalent in male patients and often presents as a unilateral deformity. The most common residual deformities observed are equinus and adduction. Conclusion Stress radiographs play a crucial role and show significant angular changes that help evaluate deformity flexibility and severity. Larger angle differences correlated with successful casting, while smaller differences predicted surgery.