The Neglected Clubfoot

Abstract

The neglected clubfoot deformity is a major disabler of children and adults in developing nations. The bones and joints of the foot deform into fixed equinus, adductus, cavus, and supination as patients walk on the side or dorsum of the foot. There is severe obliquity of the calcaneocuboid joint, which must be corrected in most cases. An algorithmic surgical approach, using peritalar soft tissue release and selected midfoot osteotomies, corrects most deformities. In severe cases, a specific form of modified Lambrinudi triple arthrodesis is required, excising large bone wedges from the anterior process of the calcaneus. The Ponseti method of serial casting is proving applicable to developing countries in reducing the burden of disability. In developing nations, combining surgical outreach with existing community-based rehabilitation programs will improve outcomes.

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

“…Despite widespread worldwide use of the Ponseti method through targeted national programs [28,36,38,40,42], patients with neglected clubfeet still present for evaluation because of limited access to treatment facilities and lack of awareness that treatment options are available [19,28,37]. In many low-income countries, patients with congenital clubfeet present to the physician late, when parents become concerned about their children starting to walk on the deformed feet.…”

“…Eventually, the lateral column of the foot (calcaneus plus cuboid) elongates more than the medial one (talus, navicular, and cuneiform) and renders the deformity stiff [28,38]. Severe neglected clubfoot is associated with pain and difficulty in locomotion; moreover, recurrent skin breakdown with infections is observed, which sometimes can lead to amputation, especially in patients who are unable to wear shoes [37].…”

“…Many children with clubfoot in low-and middle-income countries do not receive treatment and eventually have neglected clubfoot develop, which represents a cause of societal stigma, limiting their participation in activities ranging from school attendance to work and marriage [36]. If the foot is not corrected by walking age, the effect of weightbearing worsens the equinus and varus deformities, making the clubfoot nonreducible [37]. Eventually, the lateral column of the foot (calcaneus plus cuboid) elongates more than the medial one (talus, navicular, and cuneiform) and renders the deformity stiff [28,38].…”

“…Nonoperative treatments provide lasting correction in more than 80% of patients in which treatment is begun in the first 2 years of life [8]. In many countries, however, patients do not have access to medical treatment at an early age, and present only after walking age with what has been termed neglected clubfoot [13,37]. Many children with clubfoot in low-and middle-income countries do not receive treatment and eventually have neglected clubfoot develop, which represents a cause of societal stigma, limiting their participation in activities ranging from school attendance to work and marriage [36].…”

“…in low-and middle-income countries [6,9,36,37]. Nonoperative treatments provide lasting correction in more than 80% of patients in which treatment is begun in the first 2 years of life [8].…”