Treatment of Residual Adduction Deformity in Clubfoot: The Double Osteotomy

Lourenço, Alexandre; Dias, Luciano; Zoellick, David M.; Sodré, Henrique

doi:10.1097/01241398-200111000-00003

Cited by 21 publications

(15 citation statements)

References 33 publications

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“…At first, surgery was aimed at shortening of the lateral column [21] by wedge resection and enucleation of the cuboid, or conversely, at elongating the short medial column by medial wedge cuneiform osteotomy [18]. Later, the combination of medial and lateral osteotomies was described with the aim of addressing the disease at the midfoot and the forefoot [32], together with more complex osteotomies to ease correction of the rotatory component of the deformity [23,39]; all of these were reserved for children older than 4 years where the medial cuneiform ossific nucleus is well developed [14,29]. The most widespread combination of medial and lateral osteotomy is cuboid shortening and cuneiform opening wedge osteotomy [25].…”

Section: Discussionmentioning

confidence: 99%

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

Faldini¹,

Traina²,

Martino³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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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.

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Section: Discussionmentioning

confidence: 99%

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

Faldini¹,

Traina²,

Martino³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…This is done with the ''double osteotomy'', which consists of a closing wedge osteotomy of the cuboid with an opening wedge osteotomy of the medial cuneiform (Fig. 4) [19]. Good results have been shown using this technique in children older than 4 years of age [19].…”

Section: Clubfootmentioning

confidence: 99%

Orthopaedic management of spina bifida—part II: Foot and ankle deformities

Swaroop

Dias

2011

Journal of Children's Orthopaedics

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Both congenital and acquired orthopaedic deformities are common in patients with spina bifida. Examples of congenital deformities, which are present at birth, include clubfoot and vertical talus. Acquired developmental deformities are related to the level of neurologic involvement and include calcaneus and cavovarus. Orthopaedic deformities may also result from postoperative tethered cord syndrome. The previously published Part I reviewed the overall orthopaedic care of a patient with spina bifida, with a focused review of hip, knee, and rotational deformities. This paper will cover foot and ankle deformities associated with spina bifida, including clubfoot, equinus, vertical talus, calcaneus and calcaneovalgus, ankle and hindfoot valgus, and cavovarus. In addition, this paper will address the issues surrounding skin breakdown in patients with spina bifida.

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“…According to Gordon et al [5], this procedure should be reserved for patients aged 5 years or older because the medial osteotomy is technically difficult in a small, partially ossified cuneiform and there is a high rate of medial graft dislocation with loss of correction. Lourenco et al [14] treated 39 feet with a closing wedge osteotomy of the cuboid and opening wedge osteotomy of the medial cuneiform with an average follow-up of 4.8 years and saw clinical and radiographic improvement in all patients. They also stressed the importance of a well-formed ossification centre in the medial cuneiform before osteotomy, which is usually present in children older than 4 years.…”

Section: Discussionmentioning

confidence: 99%

“…a AP view. b Lateral view the forefoot adductus is the inbalance between an elongated lateral column and a shortened medial column [14]. This "bean-shaped foot" is the result of a combination of forefoot adductus, midfoot supination, and hindfoot varus that produces an elongated lateral column of the foot and thereby an internally rotated gait [10,15].…”

Section: Discussionmentioning

confidence: 99%

Midterm results following revision surgery in clubfeet

Ettl

Kirschner

Krauspe

et al. 2007

International Orthopaedics (SICOT)

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Relapse rates of surgically treated clubfeet are about 25%. We reviewed 43 patients (57 feet) treated for relapsed clubfoot deformity between 1992 and 2001 in our department. The average age of the patients at the time of revision surgery was 5.1 years, the mean follow-up was 6.6 years. Surgical therapy was performed using an algorithm according to age groups. The mean Atar score at follow-up was 77 points, representing a good outcome. Out of 57 feet, 20 (35%) were rated excellent, 24 (42%) good, 5 (9%) fair, and 8 (14%) poor. The number of previous surgical interventions had no influence on the outcome. Using an age related surgical algorithm, good postoperative results could be achieved in most of our patients, thus improving their functional situation. This emphasises the usefulness of the proposed algorithm in the difficult situation of recurrent clubfoot, while thorough analysis of the underlying deformity remains essential.

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Treatment of Residual Adduction Deformity in Clubfoot: The Double Osteotomy

Cited by 21 publications

References 33 publications

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

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

Orthopaedic management of spina bifida—part II: Foot and ankle deformities

Midterm results following revision surgery in clubfeet

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