Peroneal nerve dysfunction in patients with complex clubfeet

Complex clubfeet represent a subset of clubfeet with unique features. Their correction requires a modification of the Ponseti casting technique and good short term results have been reported. However, these clubfeet are very difficult to treat and there is a higher chance for potential complications. We reviewed the database of patients with clubfeet treated from January 2001 to December 2009. There were 837 patients (1376 feet) with 111 (182 feet) (13%) having complex deformity. Of these, 8 patients (10 complex clubfeet) (0.7%) experienced a peroneal nerve dysfunction. Severity of the dysfunction varied from no active dorsiflexion (2 patients) to weakness for active dorsiflexion or foot eversion (6 patients). Deformity correction required an average of 5 casts (range, 1 to 8). Two patients required an Achilles tenotomy and the average ankle dorsiflexion at last follow up was 14 degrees (range: 5 to 25). No surgical releases have been required. Two patients required an ankle foot orthosis to improve gait. There were three relapses (37%) that responded to casting and 1 patient required a tibialis anterior tendon transfer. Only 3 feet have recovered the nerve dysfunction. In conclusion, repeated neurological evaluations and very careful cast placement should be performed during the treatment of complex clubfeet. The modified Ponseti technique, if applied properly, is successful in correcting these feet and avoids extensive surgical releases.