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Early intensive treatment of clubfoot. 75 feet followed for 6-11 years
B Strömqvist1, R Johnsson, K Jonsson
1Lund University Hospital Department of Orthopedics, Sweden.
Insights
This study on treating clubfeet in children found that a comprehensive approach combining physiotherapy, bracing, and surgery yields good to excellent long-term cosmetic and functional results, even with repeat operations.
Area of Science:
- Orthopedics
- Pediatric Medicine
- Rehabilitative Medicine
Background:
- Clubfoot (congenital talipes equinovarus) is a common congenital foot deformity.
- Early intervention is crucial for optimal outcomes in clubfoot treatment.
Purpose of the Study:
- To evaluate the long-term efficacy of a strict neonatal treatment protocol for clubfoot.
- To assess both cosmetic and functional outcomes, as well as radiographic changes, in treated clubfeet.
Main Methods:
- A cohort of 47 children with clubfoot underwent a protocol including early physiotherapy and bracing.
- Surgical intervention was performed in most cases around 3 months of age.
- Physiotherapy continued for the first year, with bracing for three years; repeat operations were noted in 27 feet.
Main Results:
- At an average follow-up of 8 years, cosmetic results were good/acceptable in 97% of feet, and functional results were excellent/good in 94% of feet.
- Radiographs showed a higher lateral talocalcaneal angle in control feet compared to treated feet.
- Secondary or tertiary operations did not correlate with poor outcomes.
Conclusions:
- A rigorous, multi-modal treatment protocol for neonatal clubfoot leads to favorable long-term functional and cosmetic outcomes.
- The treatment protocol, including early intervention and sustained management, effectively addresses clubfoot deformity.
- Repeat surgeries are not necessarily indicative of treatment failure and can be part of achieving good results.
Abstract:
47 consecutive children with 28 bilateral and 19 unilateral clubfeet were treated during the neonatal period according to a strict protocol including physiotherapy and bracing from the first 2 weeks of life; further, in most of the children, an operation was performed at 3 (2-5) months of age. Physiotherapy was continued during the first year of life and bracing for 3 years. 27 feet had repeat operations. No peroperative or postoperative complications were seen. At follow-up at aged 8 (6-11) years, the cosmetic result was good in 62 feet, acceptable in 12 feet, and poor in 1 foot, whereas the functional result was excellent in 51 feet, good in 21 feet, and fair in 3 feet. The radiographs showed a higher lateral talocalcaneal angle in the control feet than in the treated feet; but in other radiographic aspects, no differences were seen. The need of a secondary or even tertiary operation did not indicate a poor result.