Can Selective Soft Tissue Release and Cuboid Osteotomy Correct Neglected Clubfoot?

Abstract

Background Neglected clubfoot in older children is characterized by a stiff, nonreducible deformity with relative elongation of the lateral column of the foot with respect to the medial column. Surgical correction often has involved a double osteotomy with elongation of the medial column and shortening of the lateral column, or the use of an external fixator to achieve more gradual correction. Both approaches have shortcomings. Questions/purposes We therefore (1) used objective physical examination measurements and a functional assessment to evaluate the effectiveness of cuboid osteotomy combined with a selective soft tissue release to achieve correction of neglected clubfoot in older children, (2) determined the rate of complications, and (3) ascertained whether the initial correction achieved was maintained. Methods We reviewed 31 patients (56 feet) older than 5 years with severe, neglected nonreducible clubfoot deformity who underwent the index procedure. Minimum followup was 2 years (average, 6 years; range, 2-9 years). Postoperatively, the Laaveg and Ponseti classification and Dimeglio score were used to grade correction. Complication rates were tallied. Results According to the Laaveg and Ponseti classification, 24 feet showed excellent correction, 20 good, nine fair, and three poor at 1-year followup. These results were maintained up to the latest followup. Patients showed significant improvement of Dimeglio score after surgery (p \ 0.0001). Two patients had postoperative skin-related complications that healed without additional surgery.

Congenital idiopathic talipes equinovarus before and after walking age: observations and strategy of treatment from a series of 88 cases

“…In 6 feet that presented with partially reducible equinus-varus-supination, with complete reducibility of varus, a posteromedial release was performed. In 17 feet that presented with completely unreducible deformity due to excessive joint stiffness and excessive elongation of the lateral column of the foot, posteromedial release combined with lateral release of the subtalar joint and cuboid subtraction osteotomy fixed with a percutaneous Kirschner wire [ 22 ] was performed (Table 1 ).…”

Surgical treatment of neglected clubfoot using external fixator

“…These procedures are presented as options to treatment with external fixation 2, 5. Cuboidectomy associated with soft tissue procedures presented good results in the series published by Faldini et al 17 …”

Functional Results after Surgical Correction of Neglected and Relapsed Clubfeet

“…There is some suggestion in literature that if the primary treatment of idiopathic clubfoot is initiated after 7 months of age, the results of conservative treatment tend to be unpredictable (1) . Surgical treatment of neglected and relapsed clubfeet is an accepted modality of achieving deformity correction (4,5,10,17) . The suggested technique of soft tissue release, "a la carte " approach can effectively manage the various deformities while preventing an over do (1) .…”

“…However, surgical treatment remains a modality of treatment for neglected and relapsed clubfeet that fail to respond adequately to conservative treatment (1,4,5,9,10) .…”