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Subtalar realignment in congenital clubfoot using the Cincinnati approach
1Paediatric Orthopaedic Service, Department of Orthopaedics and Traumatology. Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N. T., Hong Kong.
Goal Of Surgery:
Surgical correction of clubfoot through an extensive and meticulous posterior, lateral, medial, subtalar, and plantar release.
Indications:
Failed conservative treatment of clubfoot at 6 months of age.
Contraindications:
Previous failed surgery with a different incision.
Preoperative Work Up:
Radiographs of both foot and ankle in the anterior-posterior and lateral projections.
Positioning And Anaesthesia:
Supine. Tourniquet. General anaesthesia. Free draping above the knee.
Surgical Technique:
Through a Cincinnati incision the Achilles tendon is exposed and lengthened and the posterior capsule excised. The talofibular and the calcaneofibular ligaments are incised and released. The plantar aponeurosis is divided and the small plantar muscles are detached. Finally a medial release is achieved having excised the abductor hallucis muscles. Release of the dorsal talonavicular joint capsule. In severe cases the calcaneoucuboid joint must also be released. The corrected position is maintained with Kirschner wires.
Postoperative Management:
Long leg cast with the knee bent at 90 degrees . Cast changed after 10 to 14 days. Eight weeks postoperatively removal of cast and Kirschner wires and prescription of a Dennis-Brown boot to be worn for 12 to 18 months.
Possible Complications:
Injury to neurovascular structures. Pin tract infection. Tightness, loosening or slipping of cast. Inadequate correction and damage to articular surfaces.
Results:
From 1985 to 1992 60 infants (70 feet) were operated. Average follow-up was 5 years (1 to 7). Assessment of clinical and functional results was based on the Magone rating system: 60% excellent, 18.6% good, 11% fair results were obtained; 2 infants had a minor skin breakdown, 7 were undercorrected and 2 were overcorrected.