Evaluation of foot bimalleolar angle in the management of congenital talipes equinovarus

The study was undertaken to establish the normal foot bimalleolar (FBM) ang le in Indian infants and to correlate it with the severity of deformity and results of treatment in congenital talipes equinovarus (CTEV). Foot tracin gs with the level of both the malleoli of 182 feet (91 normal Indian infant s) were taken. The anteromedial angle between the long axis of foot and the bimalleolar plane was taken as the FBM angle. The FBM angle in normal infa nts was calculated as 82.5 degrees. Eighty-four CTEV (51 patients) were cli nically classified as grade I(five feet; FBM angle, 73.2 degrees), grade II (21 feet; FBM angle, 66.6 degrees), and grade III (58 feet; FBM angle, 54. 7 degrees), depending on whether the foot could he passively corrected (gra de I) or had a fixed equinus and/or varus of <20 degrees (grade II) or >20 degrees (grade III). Thirty-one feet (22 patients) were followed up prospec tively after conservative (17 fret: grade I, three feet; grade II, three fe et; grade III, 11 feet) and surgical release tall grade III, 14 feet). All feet with grade I and grade II deformity and 44% (11 feet) with grade In de formity were amenable to gentle graduated manipulations and cast applicatio n, whereas 56% (14 feet) with grade III deformity underwent soft tissue rel ease. After nonsurgical treatment, the mean FBM angle was 82.3 degrees. Of the feet that underwent surgery, those with excellent (11 feet) and good co rrection (3 feet) had a mean FBM angle of 79.9 degrees and 74.3 degrees, re spectively. There were no feet with fair or poor results. The clinical seve rity of foot deformity and results of treatment correlated well with the FB M angle. Foot tracing with the FBM angle is a simple, objective, and reprod ucible clinical criterion to classify the severity of foot deformity and ev aluate the results of treatment.