Clinical and functional outcome of relapse surgery in severe congenital talipes equinovarus

From a cohort of 110 idiopathic clubfeet, 26 feet in 18 children requiring surgery for severe relapse have been studied. Surgery comprised a lateral column shortening procedure (Lichtblau) plus or minus a plantarmedial release. Surgery was staged to avoid wound complications. Preoperatively feet were prospectively categorized, according to a system reported by Dimeglio, into one of four grades. This grading system provides a clinical assessment. Children were reviewed on two subsequent occasions. At review feet were again graded and in addition appearance and functional outcome were analysed. This included an assessment of gait, activity and functional limitation. Three children were lost to follow-up leaving 22 feet in seven male and eight female patients available for review. The mean age at surgery was 43 months (23-82 months). The mean time from surgery to first and second reviews was 35 and 56 months respectively. There was a significant improvement in grading at first review compared with preoperative grading (Wilcoxon signed ranks test). Although there remained a significant improvement in grading at second review compared with the preoperative grading, there was a significant reduction in the number of feet in which grading had improved when compared with first review. There was no significant change in function between the two postoperative reviews, with the majority of children experiencing little functional limitation. There were no wound complications. We conclude that relapse surgery, involving a lateral column shortening procedure for severe clubfoot, results in a significant initial improvement when assessed using a grading system. This improvement in grading subsequently decreases over time. However, the functional outcome in such cases remains favourable.