The VMRI examination lasted an average of 15 min, and it was performed in all the children under general anaesthesia, which was induced and maintained with sevoflurane 2–6 %. In no patient was the range of motion of the ankle evaluated. No patient had had recurrence of the deformity. Group 1 and 2 patients were not ambulating, whereas group 3 patients were all ambulating at the time of the VMRI examination. Group 1 and 2 patients were still wearing a Mitchell–Ponseti brace at the time of the VMRI examination, while group 3 patients had already stopped wearing the brace when VMRI was performed. Group 1 included seven patients ranging in age from 4 to 6 months group 2, seven patients from 10 to 12 months of age and group 3, seven patients from 4 to 6 years of age. We divided the patients into three groups. At the time of the MRI evaluation, all the feet were fully corrected. All the patients had a Pirani score ranging from 4.5 to 5.5 points. All the patients wore a Mitchell–Ponseti brace up to 3 years of age. Another plaster cast was applied after tenotomy, for 3 weeks. weekly manipulation and long-leg plaster cast application (a total of 4–5 casts), which started within 2 weeks after birth, followed by percutaneous Achilles tendon tenotomy at 6–8 weeks of age. All the patients had been treated according to the Ponseti method, i.e. Volumetric magnetic resonance imaging (VMRI) of the three leg muscle compartments was obtained in a cohort of 21 patients with treated UCCF. The length of the distal tendon of the tibialis anterior and peroneus longus, as well as of the Achilles tendon, was also measured. Thanks to a volumetric MRI program in use at the Department of Radiology of our hospital, we were able to calculate the overall volume of the leg muscles and their length within the three leg compartments. Surface measurement data were obtained with that method however, no information was given on the overall volume and length of the leg muscles within their respective compartments. We measured the area of leg muscles on histologic cross-sections of foetuses and on magnetic resonance imaging (MRI) cross-scans of babies, children and adults taken midway between the joint line of the knee and the ankle, using special computer software. Muscle atrophy is primitive, since it is already present in the early stages of foetal development of congenital clubfoot and affected newborns before starting treatment. In a previous study, we showed that both foetuses and untreated newborns with unilateral congenital clubfoot (UCCF) have leg muscle atrophy on the clubfoot side.
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