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Purpose The purpose of our study was to investigate the histological, histochemical and ultrastructural aspects of the proximal femoral growth plate in slipped capital femoral epiphysis (SCFE). Methods Eight core biopsies of the proximal femoral growth plate were performed during in situ epiphysiodesis in patients with SCFE that was at the pre-slipping stage in two cases and at the mild slipping stage (Southwick angle < 30°) in six cases. After fixation, the specimens were processed for either histological or histochemical or ultrastructural studies. Results The proximal femoral growth plate was thicker than normal in the SCFE cases, and the 3:1 ratio between the thickness of the resting zone and the other zones of the plate was reversed. Chondrocytes of the proliferating, maturation, hypertrophic and degenerating zones were arranged in large clusters rather than in columns, which were separated by loose fibrillary septae that appeared moderately alcian blue positive and metachromatic. The collagen fibrils of the longitudinal septae were uniformly thin, measuring about 200 Å, whereas in the normal plate collagen fibrils were in the range of 300 to 1200 Å in thickness. Chondrocytes were elongated and smaller than normal, with a dark cytoplasm. In the degenerating zone, mineralisation of the longitudinal and transversal septae was scanty and enchondral ossification was impaired, with a few small osteoblasts forming thin bone trabeculae on the cartilage septae of the degenerating zone. Conclusion In SCFE, the proximal femoral growth plate undergoes several histological, histochemical and ultrastructural changes that precede slipping of the epiphysis since they are already present at a pre-slipping stage of the disease. The loss of solidity of the extracellular matrix and the disarrangement of the normal architecture of the physis very likely cause the consequent slipping of the proximal femoral epiphysis. SCFE aetiology remains unknown. [ABSTRACT FROM AUTHOR]

A fault containing two asperities with different strengths is considered. The fault is embedded in a shear zone subject to a constant strain rate by the motions of adjacent tectonic plates. The fault is modelled as a discrete dynamical system where the average values of stress, friction and slip on each asperity are considered. The state of the fault is described by three variables: the slip deficits of the asperities and the viscoelastic deformation. The system has four dynamic modes, for which analytical solutions are calculated. The relationship between the state of the fault before a seismic event and the sequence of slipping modes in the event is enlightened. Since the moment rate depends on the number and sequence of slipping modes, the knowledge of the source function of an earthquake constrains the orbit of the system in the phase space. If the source functions of a larger number of consecutive earthquakes were known, the orbit could be constrained more and more and its evolution could be predicted with a smaller uncertainty. The model is applied to the 1964 Alaska earthquake, which was the effect of the failure of two asperities and for which a remarkable post-seismic relaxation has been observed in the subsequent decades. The evolution of the system after the 1964 event depends on the state from which the event was originated, that is constrained by the observed moment rate. The possible durations of the interseismic interval and the possible moment rates of the next earthquake are calculated as functions of the initial state. [ABSTRACT FROM AUTHOR]

A fault system made of two segments or asperities subject to a constant strain rate is considered. The fault is modelled as a discrete dynamical system made of two blocks coupled by a Maxwell spring dashpot element and pulled at constant velocity on a rough plane. The long-term behaviour of the fault is studied by calculating the orbits of the system in the phase space. The model shows the role of viscoelastic relaxation in the Earth's crust in controlling the occurrence times of earthquakes. If a viscoelastic coupling is present, earthquakes are anticipated or delayed with respect to the elastic case. The limit cycles made of two alternate asper- ity failures, which are observed in the case of purely elastic coupling, are no longer produced. The model is applied to the 1964 Alaska earthquake, which was the effect of the failure of two asperities and for which a remarkable post-seismic relaxation has been observed in the subsequent decades. In such a fault system, viscoelastic coupling of the asperities appears to have a great influence on the occurrence times of earthquakes. [ABSTRACT FROM AUTHOR]

Abstract: We model a lava flow as a one-dimensional flow of a pseudoplastic fluid with viscous dissipation. The flow is horizontally unbounded and is driven downslope by the gravity force. We consider a power-law constitutive equation and we take into account the temperature dependence of the rheological parameters. Given an effusion rate and an initial temperature at the eruption vent, the flow is assumed to cool down by heat radiation. We calculate the heat produced by viscous dissipation as a function of lava temperature and effusion rate. The cooling rate is calculated as a function of the surface temperature and flow rate. Viscous dissipation reduces the cooling rate by an amount which is independent of flow rate. We evaluate the effect of viscous dissipation on the flow thickness and velocity. The effect of dissipation is to decrease the flow thickness and to increase the flow velocity. The effect on flow thickness is greater for smaller flow rates, while the effect on velocity is greater for larger effusion rates. In principle, the model provides a method for estimating the flow rate from in-field measurements of distances and temperatures. [Copyright &y& Elsevier]

A fault with two asperities is modelled as a system made of two blocks coupled by a spring and sliding on a plane under the same values of static and dynamic friction. An analytical solution is given for the simultaneous motion of the blocks and the corresponding orbits are plotted in the phase space. It is proven that, whichever the initial state is, the long-term behaviour of the system is one of an infinite number of limit cycles, characterized by a particular pattern of forces. The region where the system is located when the blocks are stationary can be divided into narrow stripes corresponding to different orbits of the points belonging to them. This implies that the system is sensitive to perturbations and has relevant implications for a fault, which is subject to stress transfers from earthquakes generated by neighbouring faults. In this case, the fault may experience a larger earthquake, with the simultaneous failure of the two asperities, which restores a stress distribution compatible with periodic behaviour. The seismic moment associated with simultaneous asperity failure is always greater than the maximum value that can be released in a limit cycle. For strongly coupled asperities, the moment can be several times larger. [ABSTRACT FROM AUTHOR]

The behaviour of seismogenic faults is generally investigated under the assumption that they are subject to a constant strain rate. We consider the effect of a slowly variable strain rate on the recurrence times of earthquakes generated by a single fault. To this aim a spring-block system is employed as a low-order analog of the fault. Two cases are considered: a sinusoidal oscillation in the driver velocity and a monotonic change from one velocity value to another. In the first case, a study of the orbit of the system in the state space suggests that the seismic activity of the equivalent fault is organized into cycles that include several earthquakes and repeat periodically. Within each cycle the recurrence times oscillate about an average value equal to the recurrence period for constant strain rate. In the second case, the recurrence time changes gradually from the value before the transition to the value following it. Asymptotic solutions are also given, approximating the case when the amplitude of the oscillation or of the monotonic change is much smaller than the average driver velocity and the period of oscillation or the duration of the transition is much longer than the recurrence times of block motions. If the system is not isolated but is subject to perturbations in stress, the perturbation anticipates or delays the subsequent earthquake. The effects of stress perturbations in the two cases of strain rate oscillations and monotonic change are considered. [ABSTRACT FROM AUTHOR]

By means of a 2D finite-element procedure, we tested how heterogeneities at the scale of seismogenic fault affect the displacement. We defined one or more slip distributions for two typical normal-faulting earthquakes in the Central Apennines, computed the displacement occurred within different structures including lateral heterogeneities, and compared the different displacement profiles to isolate the effect of the crustal structure. To understand at what magnitude the heterogeneities affect the observation significantly, we compared the predicted coseismic displacement with GPS and DInSAR data for the Colfiorito 1997 earthquake. We find that heterogeneities significantly affect the observable horizontal coseismic displacement for the larger magnitudes, whereas for smaller quakes, they affect horizontal displacement close to the fault trace only. [ABSTRACT FROM AUTHOR]

Okada (1992) provided expressions for the displacement and strain fields due to a finite rectangular source in an elastic, homogeneous and isotropic half-space. Starting with these results, we applied the correspondence principle of linear viscoelasticity to derive the quasi-static displacement, strain and stress fields in a viscoelastic, homogeneous and isotropic half-space. We assume that the medium deforms viscoelastically with respect to both the shear and the normal stresses but keeps a constant bulk modulus; in particular, the shear modulus relaxes as Maxwell fluid. We presented the viscoelastic effect on displacement, displacement gradient and stress fields, for a choice of parameter values. The viscoelastic effect due to the sudden dislocation reaches a limit value after about 10 times the Maxwell time. The expressions obtained here provide tools for the study of viscoelastic relaxation of lithosphere associated with seismic and volcanic phenomena. [ABSTRACT FROM AUTHOR]

It is generally agreed that the occurrence of seismic sequences implies a kind of interaction between different fault segments. The coseismic stress transfer produced by each dislocation is the most obvious component of such an interaction. However, the time intervals elapsing between subsequent events in a sequence indicate that the coseismic stress is not sufficient to trigger other seismic events by itself. We investigate the possibility that the coseismic stress field may induce flow of pore fluids, altering the pore pressure distribution in the region. Since the crust is a fluid-saturated medium at many locations, we consider the crust as a poroelastic solid. Because poroelastic materials exhibit time-dependent stress fields, we examine if this behaviour can explain the triggering of aftershocks. We consider some available analytical solutions for a semi-infinite plane fault. Permeable and impermeable dislocation planes are considered. We compare the solutions for a poroelastic medium with those for a porous medium, and evaluate the effect of the coupling between deformation and fluid diffusion. We find that the Coulomb stress changes due to the main shock may be initially negative at some locations, but become positive as pore fluids are redistributed. These changes are significantly large. If the crust were to behave as an isotropic, fluid-filled, poro-elastic medium, as we assume here, Coulomb stress triggering by means of pore fluid diffusion is likely an important mechanism for aftershock generation over distances and widths of about 2.5 and 0.5 fault lengths, respectively. These distance ranges are smaller than those predicted by previous models which disregarded the mechanical interactions between elastic deformation and pore fluid diffusion. For typical porosities, the stress changes due to fluid flow are diminished greatly after about 1 yr after the main shock. [ABSTRACT FROM AUTHOR]

During 1997 several slow earthquakes have been recorded by a geodetic interferometer located beneath Gran Sasso, central Italy. The strain rise times of the events range from tens to thousands of seconds and strain amplitudes are of the order of 10−9. Amplitudes scale with the square root of the rise time and this suggests a diffusive behaviour of the slip propagation along the fault. In this work, we develop a model in which slip diffusion is the result of the presence of a gouge layer between fault faces, with a viscoplastic rheology. The fluid velocity field in the gouge layer diffuses in the directions of fault length and fault thickness, with different characteristic times. This model reproduces the relation between amplitude and rise time of measured strain signals. Synthetic straingrams, obtained for a horizontally layered, flat Earth and a source located a few kilometres from the instrument, are in agreement with observed signals. [ABSTRACT FROM AUTHOR]

We studied the conditions of crust and tube formation of a lava flow moving under the effect of gravity in a rectangular cross-section channel and assumed a power-law rheology for lava. We followed the work of Valerio et al. (2008), who studied the effect of surface cooling on the formation and accretion of the crust in the central region of the channel, assuming for lava a Newtonian rheology. According to these authors, tube formation is influenced by topography and channel morphology. In this work, we extended this study to a non-Newtonian rheology, in particular to the power-law rheology. Results indicate that a power-law rheology strongly influences the condition of crust formation but does not produce significant differences as a function of topographical or morphological variations. [ABSTRACT FROM AUTHOR]

Background: eHealth Literacy (eHL) is a set of competencies and skills encompassing the knowledge, comfort and perceived ability to identify, evaluate and apply electronic health information to health problems. Given its role in the appropriate use of health technologies, ensuring equitable access to health information and improving patient outcomes, this study aims to systematically retrieve, qualitatively and quantitative pool and critically appraise available experimental evidence on the effectiveness of eHL interventions across different population groups., Methods: Following the PRISMA guidelines, we conducted a systematic review in PubMed/Medline, Scopus, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov, including original experimental studies quantifying the effectiveness of interventions aimed at increasing eHL, as assessed by the eHealth Literacy Scale (eHEALS) or other validated scales. We performed a random-effects model meta-analysis comparing changes in eHL levels before and after the interventions, and between the intervention and control groups. Heterogeneity was assessed using I 2 statistics., Results: Out of the 504 studies retrieved, 15 studies conducted between 2011 and 2023 met the inclusion criteria. Target populations of eHL interventions included adults in 7 studies, older people in 5 and young people in 4. The meta-analysis included 10 studies that used the eHEALS. Participants showed a mean increase in eHEALS scores of 5.81 points (95% CI = 3.36-8.26, N = 1025) following the eHL interventions compared to the pre-intervention period. In the analysis between the intervention and control groups, we found a statistically significant difference in eHL improvement in favour of the intervention group, with mean eHEALS scores 3.62 points (95% CI = 1.63-5.60, N = 1258) higher in the intervention group than in the control groups. Subgroup analyses by intervention type, stratified by Collaborative Learning (CL) or Individualistic Learning (IL) showed significant increases in eHealth Literacy in the pre-post intervention analysis (CL: UMD = 5.19, CI = 0.01-10.38, N = 402; IL: UMD = 6.05; CI = 3.14-8.97, N = 623) and in the intervention vs. control analysis in the IL group (DMD = 4.98; CI = 1.77-8.12, N = 540)., Conclusions: Our findings support the effectiveness of tailored interventions in significantly enhancing eHL, providing key insights for evidence-based intervention design targeted to different population groups., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Clinical trial number: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

The onset of cancer disease is a traumatic experience for both patients and their families that suddenly change the patient's life and is accompanied by important physical, emotional, and psycho-social problems. The complexity of this scenario has been exacerbated by the COVID-19 pandemic which dramatically affected the continuity of the provision of optimal care to chronic patients. Telemedicine can support the management of oncology care paths by furnishing a suite of effective and efficient tools to monitor the therapies of cancer patients. In particular, this is a suitable setting for therapies that are administered at home. In this paper, we present an AI-based system, called Arianna, designed and implemented to support and monitor patients treated by the professionals belonging to the Breast Cancer Unit Network (BCU-Net) along the entire clinical path of breast cancer treatment. We describe in this work the three modules composing the Arianna system (the tools for patients and clinicians, and the symbolic AI-based module). The system has been validated in a qualitative way and we demonstrated how the Arianna solution reached a high level of acceptability by all types of end-users by making it suitable for a concrete integration into the daily practice of the BCU-Net., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Explainable AI aims at building intelligent systems that are able to provide a clear, and human understandable, justification of their decisions. This holds for both rule-based and data-driven methods. In management of chronic diseases, the users of such systems are patients that follow strict dietary rules to manage such diseases. After receiving the input of the intake food, the system performs reasoning to understand whether the users follow an unhealthy behavior. Successively, the system has to communicate the results in a clear and effective way, that is, the output message has to persuade users to follow the right dietary rules. In this paper, we address the main challenges to build such systems: (i) the Natural Language Generation of messages that explain the reasoner inconsistency; and, (ii) the effectiveness of such messages at persuading the users. Results prove that the persuasive explanations are able to reduce the unhealthy users' behaviors., (Copyright © 2020. Published by Elsevier B.V.)

Background: Isolated intra-articular radial head (IARH) fractures in skeletally immature patients represent a rare injury. Despite their initial benign radiologic appearance, these fractures are at risk for progressive radial head subluxation and may end with degenerative irreversible changes of the radiocapitellar joint. The aim of this study is to highlight the seriousness of these injuries and the importance of early diagnosis and a proper follow-up to achieve optimal outcomes., Methods: We retrospectively reviewed 6 patients with IARH fractures treated at our institution between 2011 and 2016. All patients presented with Salter-Harris types III or IV fracture. Five of 6 fractures were initially undisplaced. Treatment, clinical, and radiographic results were analyzed. Patients were divided into 2 groups according to treatment: patients included in group A were treated conservatively, whereas patients of group B were treated with early surgery. The final functional outcome was assessed using the Oxford Elbow Score (OES). The Broberg-Morrey classification was used for the radiographic results., Results: Group A included 3 patients (average age, 11±2 y). They developed an initially missed posterior subluxation of the radiocapitellar joint that caused to all of them a painful elbow and limited range of motion (ROM). Despite rescue surgery, they all presented with limited ROM at the final follow-up, although no functional limitations (OES, 46.3±2.9). The radiographs showed early degenerative changes. Group B included 3 patients (average age, 11±1 y) all treated surgically within 1 week from the injury. They showed no limitation of ROM and good functional (OES, 47.7) and radiologic outcomes., Conclusions: IARH fractures in skeletally immature children are deceptive injuries which are often underestimated. Surgeons should be aware of these fractures, especially when a discrepancy between the clinical signs and symptoms, and the radiologic appearance exists, as this may be the only red flag that allows their identification in the acute setting. An early and accurate diagnosis followed by prompt and more aggressive treatment when necessary is mandatory for successful results., Level of Evidence: Level IV-case series.

In our study, we aimed to demonstrate whether a complex iatrogenic clubfoot really exists; identify the causative mechanisms; and determine the outcome if properly treated. We observed 54 clubfeet previously treated unsuccessfully by manipulation and casting elsewhere. All the feet had been classified at diagnosis as typical clubfeet. In 26 cases, the cast had slipped down, entrapping the foot in a plantar-flexed position. Nine clubfeet out of those 26 cases presented the clinical features of a complex iatrogenic deformity. These were treated with the modified Ponseti protocol and evaluated at follow-up according to the International Clubfoot Study Group Score. The length of follow-up averaged 7.2 years. Two feet showed an excellent result, five feet showed a good result, and two feet showed a fair result. The relapse rate was 55% in complex clubfeet. Relapsed clubfeet were treated by Achilles tenotomy or lengthening and anterior tibial tendon transfer. We believe that faulty manipulation and a poor casting technique may convert a typical clubfoot into a complex iatrogenic deformity. Risk factors include severe clubfoot, short and stubby foot, and unmolded casts slipping down.

Automatically monitoring and supporting healthy lifestyle is a recent research trend, fostered by the availability of low-cost monitoring devices, and it can significantly contribute to the prevention of chronic diseases deriving from incorrect diet and lack of physical activity. In this paper, we present a general purpose architecture for persuasion scenarios and behavioral change. The architecture is designed to be easily portable across languages and domains and has been implemented and evaluated in a specific system for Workplace Health Promotion (WHP) called PerKApp. PerKApp provides a fully fledged platform supporting the remote monitoring of workers lifestyle by providing real-time feedback through persuasive context-based messages when necessary., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: There is no established treatment for rigid residual deformity of congenital clubfoot (CCF) after walking age. Soft-tissue procedures, osseous procedures, and external fixation have been performed with unpredictable results. We applied the Ponseti method to patients with this condition in order to improve the outcomes of treatment., Methods: We retrospectively reviewed the cases of 44 patients (68 feet) with congenital clubfoot whose mean age (and standard deviation) at treatment was 4.8 ± 1.6 years. All patients had been previously treated in other institutions by various conservative and surgical protocols. Residual deformity was evaluated using the International Clubfoot Study Group Score (ICFSGS), and stiffness was rated by the number of casts needed for deformity correction. Ponseti manipulation and cast application was performed. Equinus was usually treated with percutaneous heel-cord surgery, while the cavus deformity was treated with percutaneous fasciotomy when needed. Tibialis anterior tendon transfer (TATT) was performed in patients over 3 years old. At the time of follow-up, the results were evaluated using the ICFSGS., Results: Before treatment, 12 feet were graded as fair and 56, as poor. Two to 4 casts were applied, with each cast worn for 4 weeks. Stiffness was moderate (2 casts) in 23 feet, severe (3 casts) in 30 feet, and very severe (4 casts) in 15 feet. Percutaneous heel-cord surgery was performed in 28 feet; open posterior release, in 5 feet; plantar fasciotomy, in 30 feet; and TATT, in 60 feet. The mean length of follow-up was 4.9 ± 1.8 years. Eight feet had an excellent result; 49 feet, a good result; and 11 feet, a fair result. No patient had pain. All of the feet showed significant improvement., Conclusions: Ponseti treatment with TATT, which was performed in 88% of the feet, was effective, and satisfactory results were achieved in 84% of the feet. At the time of follow-up, no patient showed an abnormal gait, all feet were plantigrade and flexible, but 2 feet (2.9%) had relapsed., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence., (Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.)

The authors report the results of long-term follow-up in 29 patients treated for non-union of the carpal navicular with a modified Murray technique performed through a lateral approach. Mean patient age at surgery was 22.5 years. Average time from injury to surgery for nonunion was 18 months. In 5 cases, mild signs of osteoarthritis of the radioscaphoid joint (scaphoid nonunion advanced collapse [SNAC] stage I) were present before surgery, and in 2 cases, radiographic signs of avascular necrosis of the proximal nonunion fragment were evident. In all cases, a corticocancellous nonvascularized bone graft taken from the distal part of the ipsilateral radius was used. Mean follow-up was 11.2 years. Nonunion had healed in 93.1% of cases. At follow-up, the 2 patients in whom nonunion had not healed had severe painful osteoarthritis of the wrist (SNAC stage IV). Twenty patients were asymptomatic, and 5 had occasional pain in the wrist. Wrist range of motion was restricted in all patients compared with the contralateral side. Mild osteoarthritis was observed in 6 patients (SNAC stage I). The average Disabilities of the Arm, Shoulder and Hand score was 8.7 of 100. The modified Murray technique is reliable for treating nonunion of the carpal navicular. The union rate is high, and the incidence of wrist osteoarthritis is low compared with other studies. Early diagnosis and treatment of nonunion (a short interval between fracture and surgery) can minimize the risk of degenerative joint disease. Avascular necrosis of the proximal fragment is not an absolute contraindication to surgery., (Copyright 2015, SLACK Incorporated.)

We report a case of a painful accessory ossification centre of the medial malleolus in an 11-year-old girl who was not involved in sports activities. The patient was treated conservatively, with complete clinical and radiographic healing of the medial malleolus 6 months after the first presentation. We ruled out the uncommon pathological conditions causing chronic pain in the medial malleolus during skeletal growth, such as traction apophysitis of the medial malleolus, osteochondrosis, osteochondritis or avascular necrosis of the distal tibial epiphysis. We speculate that this painful condition may be classified as an osteochondrosis of the accessory ossification centre of the medial malleolus.

Purpose: To investigate both volume and length of the three muscle compartments of the normal and the affected leg in unilateral congenital clubfoot., Methods: Volumetric magnetic resonance imaging (VMRI) of the anterior, lateral and postero-medial muscular compartments of both the normal and the clubfoot leg was obtained in three groups of seven patients each, whose mean age was, respectively, 4.8 months, 11.1 months and 4.7 years. At diagnosis, all the unilateral congenital clubfeet had a Pirani score ranging from 4.5 to 5.5 points, and all of them had been treated according to a strict Ponseti protocol. All the feet had percutaneous lengthening of the Achilles tendon., Results: A mean difference in both volume and length was found between the three muscular compartments of the leg, with the muscles of the clubfoot side being thinner and shorter than those of the normal side. The distal tendon of the tibialis anterior, peroneus longus and triceps surae (Achilles tendon) were longer than normal on the clubfoot side., Conclusions: Our study shows that the three muscle compartments of the clubfoot leg are thinner and shorter than normal in the patients of the three groups. The difference in the musculature volume of the postero-medial compartment between the normal and the affected side increased nine-fold from age group 2 to 3, while the difference in length increased by 20 %, thus, showing that the muscles of the postero-medial compartment tend to grow in both thickness and length much less than the muscles of the other leg compartments.

Tibiofibular torsion was measured by computed tomography in three series of patients affected by congenital clubfoot who were treated with different protocols. The normal leg of unilateral deformities served as the control. For the bilateral cases, only the right side was included in the study. The angle between the bicondylar axis of the tibia and the bimalleolar axis was the index of tibiofibular torsion. There were 34 clubfeet in the first series, treated with a posteromedial release, and 40 clubfeet in the second series, treated with a modified Ponseti method, whereas the third series included 16 clubfeet, treated with the original Ponseti method. All 90 clubfeet were graded at birth as group 3 according to the Manes classification. No patient had previous treatment. The patients of the first and the second series were followed up to maturity, whereas the patients of the third series were followed up to a maximum of 11 years of age. In the congenital clubfoot, the tibia and the fibula were externally rotated, in comparison with the normal leg; in fact, the average value of the angle of tibiofibular torsion was 32.2° in the first series, 23.9° in the second series, and 21.1° in the third series. In the normal tibiae, the average value of the angle of tibiofibular torsion was 21.4°. The difference between the first series and the normal controls was statistically significant, as was the difference between the first one and the other two series. The value of the tibiofibular torsion angle seems to be related to the manipulation technique used to treat clubfoot: when the manipulation does not allow a progressive eversion of the talus underneath the calcaneus, the external tibial torsion increases. At follow-up, an intoeing gait was present in seven treated clubfeet of the first series. In all of them except one, the highest value of the external tibial torsion angle was observed, with a low value of the Kite's angle and/or residual forefoot adduction. In the treated congenital clubfoot, persistent intoeing is not related to the angle of tibial torsion but rather to the amount of correction of calcaneal inversion and residual forefoot adduction.