Original Research Prognostic Value of the Radiologic Appearance of the Navicular Ossification Center in Congenital Talipes Equinovarus Abiola A. Atanda, MD 1 , Julius K. Oni, MD 2 , David M. Ramsden, BS 3 , Richard S. Yoon, MD 1 , Alaa A. Ahmad, MD 4 , Norman Y. Otsuka, MD 5 1 Resident, Department of Orthopaedic Surgery, Center For Children, New York University Hospital for Joint Diseases, New York, NY 2 Assistant Professor of Orthopaedic Surgery, Einstein Medical Center, Philadelphia, PA 3 Medical Student, University of Massachusetts Medical School, Worcester, MA 4 Pediatric Orthopaedic Surgeon, An-Najah University Teaching Hospital, Nablus, Palestine 5 Professor of Orthopaedic Surgery, Albert Einstein College of Medicine, Chief, Pediatric Orthopaedics, The Children’s Hospital at Montefiore, Bronx, New York article info Level of Clinical Evidence: 3 Keywords: clubfoot congenital talipes equinovarus navicular ossification center outcome tarsal abstract Congenital talipes equinovarus (CTEV), more commonly known as clubfoot, is a deformity of the foot that is not well understood. The tarsal navicular is at the center of the disease process and exhibits abnormal development and delayed ossification. However, its role in the pathologic process is not clear. The aim of the present study was to better understand the role of the tarsal navicular in CTEV by correlating the presence of the navicular ossification center and relapse of clubfoot deformity after surgical treatment. The medical re- cords and radiographs of 34 patients (41 feet) with surgically treated CTEV were reviewed for the presence of the navicular ossification center and the lateral talocalcaneal angles. Of the 41 feet,17 (41.46%) did not have the tarsal navicular ossification center present before surgery, and 24 (58.54%) did have the ossification center present. The talocalcaneal angles were similar between those with and without the navicular ossification center present. No significant difference was found in the incidence of relapse between the nonossified navicular group (17.6%) and the ossified navicular group (16.7%; p ¼ .63). The presence of the navicular ossification center before surgery does not appear to have prognostic value for the relapse of CTEV after surgical intervention. Ó 2015 by the American College of Foot and Ankle Surgeons. All rights reserved. Congenital talipes equinovarus (CTEV), more commonly known as clubfoot, is a common pediatric foot deformity, with an estimated incidence of 1 to 2 per 1000 live births (1). This congenital deformity consists of a combination of hindfoot equinus (plantar flexed), hindfoot varus (inverted), midfoot cavus (high arch), and forefoot adductus. The current reference stan- dard for treating clubfoot is the Ponseti method (2). The Ponseti method includes serial casting with bracing, which requires the child to wear a foot abduction brace for 2 or more years (2,3). Although most patients treated with the Ponseti method will experience excellent long-term outcomes, a significant number of patients will still require operative intervention (approximately 10% in 2006) (4). Tarsal bones, especially the navicular, will develop abnormally in patients with clubfoot deformity, and long-term studies have shown marked deformity and osteoarthritis of the navicular into adulthood (5–7). In CTEV, the tarsal navicular experiences medial subluxation, abnormal ossification, long-term deformity, and osteoarthritis (5–7). These abnormalities confirm the importance of the tarsal navicular in the pathologic features and outcome of CTEV. These studies also prompt the question of whether the tarsal navicular’s development, especially in cases of CTEV requiring surgical intervention, has any relationship to the outcomes. Because CTEV surgeries are not benign procedures without risk (8), prognostic indicators would be of high utility. We are not aware of any published studies that have evaluated the possible prognostic sig- nificance of tarsal navicular ossification before surgical intervention. Given its abnormalities in CTEV and the susceptibility of damage with its late ossification, we hypothesized that the presence of the navic- ular ossification center before surgery would serve as a positive prognostic indicator for the surgical treatment of CTEV. This case- control study, therefore, aimed to evaluate the appearance of the Financial Disclosure: None reported. Conflict of Interest: None reported. Address correspondence to: Norman Y. Otsuka, MD, Department of Orthopaedic Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, 6th Floor, Bronx, NY 10467. E-mail address: norman.y.otsuka@gmail.com (N.Y. Otsuka). 1067-2516/$ - see front matter Ó 2015 by the American College of Foot and Ankle Surgeons. All rights reserved. http://dx.doi.org/10.1053/j.jfas.2015.01.007 Contents lists available at ScienceDirect The Journal of Foot & Ankle Surgery journal homepage: www.jfas.org The Journal of Foot & Ankle Surgery xxx (2015) 1–4