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Thesis
Volumetric and growth changes induced by serial casting treatment of congenital clubfoot on tarsal bones
Master of Science (M.S.), Drexel University
2014
DOI:
https://doi.org/10.17918/etd-4490
Abstract
Clinically identified as talipes equinovarus, clubfoot is a developmental deformity that is treated with the Ponseti method of casting and manipulation. While the success of this procedure in correcting the deformity is well documented, the method of correction is poorly understood. The spatial and temporal composition of the developing tarsal anlagen was first inspected to identify the properties that allow realignment and reshaping of the deformed anlagen. The volumetric changes over the course of treatment were then quantified to see if the Ponseti treatment affected the rate of growth of anlagen and ossific nuclei and the percent ossification of anlagen. The conventional view that the primary effect of the Ponseti treatment was to realign the tarsal anlagen and initiate subsequent changes in the shape of the anlagen was challenged by studying the immediate and overall shape changes introduced by manipulation and casting. Fourier Transform Infrared Spectroscopy (FTIRIS) was utilized to understand the spatial and temporal changes in the anlagen composition during the developmental process. The endochondral ossification progression was marked by an increase in the collagen levels in the deeper region, especially closer to the growing ossific nuclei. The orientation of these collagen fibrils stayed constant till the formation of the ossific nuclei and then the fibrils were randomly oriented to facilitate the transformation from cartilage to bone. The mineralization was also preceded by a decrease in proteoglycan levels. Collagen integrity increased with age and the increased synthesis of collagen was followed by constant formation of newer crosslinks. Three dimensional modeling of MRI images were used to study the effect of Ponseti treatment on the volume and shape of deformed clubfoot. Ponseti treatment affected the compositional changes by stimulating the growth of the deformed anlagen, especially talus, at a higher rate compared to normal anlagen. Volumetric analysis showed that the significantly different clubfoot and normal foot have more comparable volume by the end of treatment. Shape change analyses confirmed the immediate shape changes induced by casting, increased convexity of the wedged talar dome and calcaneus head, and the presence of residual deformity present at the end of treatment. However, over the course of treatment, the smaller and deformed anlagen grow and adapt to obtain the shape and volume that is close enough to the normal foot to mimic normal functionality.
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Details
- Title
- Volumetric and growth changes induced by serial casting treatment of congenital clubfoot on tarsal bones
- Creators
- Phitha Philip - DU
- Contributors
- Sorin Siegler (Advisor) - Drexel University (1970-)
- Awarding Institution
- Drexel University
- Degree Awarded
- Master of Science (M.S.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Resource Type
- Thesis
- Language
- English
- Academic Unit
- School of Biomedical Engineering, Science, and Health Systems (1997-2026); Drexel University
- Other Identifier
- 4490; 991014632076404721