J Korean Orthop Assoc.  2019 Dec;54(6):547-556. 10.4055/jkoa.2019.54.6.547.

Long-Term Results of Surgical Treatment for the Idiopathic Clubfoot

• Kim HT
• Kim IH
• Cho YJ
• Ahn TY

• KMID: 2469886
• DOI: http://doi.org/10.4055/jkoa.2019.54.6.547

Abstract

PURPOSE
This study evaluated the results of surgical treatment for residual or recurrent deformity after the conservative treatment of idiopathic clubfoot.
MATERIALS AND METHODS
Fifty-one cases (32 patients), who were followed up to skeletal maturity, were reviewed retrospectively. The mean age at the last follow-up was 18.7 years. The surgical options included selective or comprehensive soft tissue release, tendon lengthening and transfer, and various types of osteotomy. The radiology measurements included the talocalcaneal angle and talo-first metatarsal angle in the anteroposterior (AP) view, and the talocalcaneal angle and calcaneal pitch in the lateral view. The radiology measurements were compared with the normal values for adults. The clinical evaluations were made using the ankle-hindfoot score and the midfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS): excellent (>85), good (71-85), pair (56-70), and poor (< 56).
RESULTS
At the last follow-up, the percentages of the 51 cases, whose parameter values fell within the normal ranges were as follows: in the AP view, 41.2% (talocalcaneal angle); and 90.2% (talo-first metatarsal angle). In the lateral view, the percentage was 84.3% (talocalcaneal angle). For the calcaneal pitch, the percentages were 61%. The mean AOFAS score was 88.1±10.7 on the ankle-hindfoot score and 86.7±11.5 on the midfoot score.
CONCLUSION
The long-term outcome of patients with idiopathic clubfoot, who underwent surgical treatment after conservative treatment, was found to be 43%-90% of the normal range of radiographic indices. Clinically, the mean AOFAS scores were "excellent". Therefore, a satisfactory result can be obtained by analyzing the elements of deformity more accurately and then using the selective operation method, even if the non-surgical correction method fails.

Keyword

clubfoot; surgery

MeSH Terms

Adult
Ankle
Clubfoot*
Congenital Abnormalities
Follow-Up Studies
Foot
Humans
Metatarsal Bones
Methods
Osteotomy
Reference Values
Retrospective Studies
Tenotomy

Figure

• 

  Figure 1 (A) Photograph of a 4 year and 4 month old boy showing internal rotation of the left lower leg when both patellae were kept forward in the sitting position (case no. 51). He had undergone cast corrections using the Ponseti technique 6 times for his left clubfoot (Dimeglio grade IV) beginning 2 weeks after birth. He subsequently underwent posteromedial release at the age of 11 months due to recurrence of the deformity even with continuous physical therapy (foot and heel stretching) and long- and short-leg club foot braces. (B) Standing anteroposterior and (C, D) lateral radiographs of the both feet (C: left, D: right) show mild residual forefoot varus deformity and reduced talar tilt angle on the left foot compared to the right. He underwent posterior release, including Achilles tendon lengthening, (E) closed wedge osteotomy of the cuboid and open wedge osteotomy of the medial cuneiform, total transfer of the tibialis anterior tendon to the cuboid, and (F) distal tibiofibular external rotation (20°) osteotomy. After surgery, the foot deformities improved. The toe-in gait was improved. (G) Standing anteroposterior and (H, I) lateral radiographs of both feet (H: left, I: right) taken when the patient was 18 years old. He does not have any problems in daily living activities. His only complaint was dull foot and ankle pain after playing soccer. The American Orthopaedic Foot and Ankle Society (AOFAS) scores were 88 (ankle-hind foot) and 88 (midfoot).

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