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Surgical management of resistant idiopathic congenital clubfoot
Y L Chang1, S C Huang, T K Liu
1Department of Orthopedic Surgery, Lo-Tung Poh-Ai Hospital, I-Lan Hsien, Taiwan, R.O.C.
Insights
Early surgical release is effective for neglected or resistant clubfeet, achieving excellent outcomes in 96% of cases. Both limited and radical release methods show high satisfaction rates with manageable complications.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Congenital Foot Deformities
Background:
- Neglected or conservative treatment-resistant clubfeet often require surgical intervention.
- There is a growing trend towards early and individualized surgical release for these cases.
Purpose of the Study:
- To evaluate the outcomes of early and tailored surgical release for neglected or resistant clubfeet.
- To compare the effectiveness of limited versus radical release procedures.
Main Methods:
- Operative treatment of 53 clubfeet in 37 children (aged 4 months to 8 years) using the Cincinnati incision for one-stage release.
- Categorization into limited (23 feet) and radical (30 feet) release groups.
- Follow-up averaging 3.5 years with evaluation of physical, functional, and roentgenographic findings.
Main Results:
- 96% of treated clubfeet achieved good or excellent results based on the modified Magone rating scale.
- Both limited and radical release groups reported high satisfaction.
- Limited release significantly improved the tibio-calcaneal angle, while radical release improved all measured angles.
Conclusions:
- Early and adequate surgical release is a successful treatment for neglected or resistant clubfeet.
- Meticulous surgical technique and understanding of pathoanatomy can minimize complications.
- No significant difference in outcomes was observed between different age groups.
Abstract:
For neglected clubfeet or clubfeet resistant to conservative treatment, there is an increasing tendency towards early and tailored release. From November 1983 to November 1987, we operated on 37 children with 53 neglected or resistant clubfeet which included 23 with limited release and 30 with radical release. Their ages ranged from 4 months to 8 years with an average age of 1 year 5 months. Operative treatment was indicated if the clubfeet had been neglected or had shown no corrective change after 12 weeks of intensive plaster treatment. We used the Cincinnati incision for one-stage release. The average follow-up was 3.5 years (range 2-5.5 years). Evaluation criteria included physical, functional and roentgenographic findings. The results were good or excellent in 96% of the feet based on the modified Magone rating scale. There was no significant difference in the operation results between different age groups. Both the limited and the radical release groups had a high rate of satisfaction. The limited procedure only effectively improved the tibio-calcaneal angle to a significant degree (p less than 0.01), while the radical operation changed every angle significantly (p less than 0.01). Complications included calf muscle atrophy in 4 feet, overcorrection in 3 feet, undercorrection in 3 feet, superficial skin necrosis in one foot, pin tract infection in one foot and residual metatarsal adductus in one foot. In conclusion, neglected or resistant clubfeet can be treated by early and adequate release with a high rate of success. Complications can be avoided by a thorough understanding of their pathoanatomy and by a meticulous surgical approach and release.