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Long-term Results After Extensive Soft Tissue Release in Very Severe Congenital Clubfeet
Fanny Alkar1, Djamel Louahem, Frédérique Bonnet
1*Orthopaedic Pediatric Surgery Department, Lapeyronie University Hospital, Montpellier †Saint-Pierre Pediatric Rehabilitation Center, Palavas les Flots, France.
Insights
Long-term follow-up of severe congenital idiopathic clubfeet treated with extensive soft tissue release shows high patient satisfaction despite frequent residual deformities and pain. Patient satisfaction was linked to gait perception and initial severity, not just surgical outcomes.
Area of Science:
- Pediatric Orthopedics
- Congenital Malformations
- Surgical Outcomes
Background:
- Congenital idiopathic clubfoot is a common birth defect.
- Very severe cases pose significant treatment challenges.
- Long-term outcomes of extensive surgical interventions are crucial for understanding disease progression and management.
Purpose of the Study:
- To evaluate the long-term results of treating very severe congenital idiopathic clubfeet.
- To assess patient satisfaction and functional outcomes after an average of 22 years.
- To identify factors influencing satisfaction and long-term sequelae.
Main Methods:
- Retrospective analysis of 66 patients (105 clubfeet) with very severe clubfoot (Dimeglio-Bensahel scale).
- Treatment involved extensive infant soft tissue release.
- Outcomes assessed using Ghanem-Seringe scoring, patient-reported pain and function, and radiographic evaluation.
Main Results:
- 92% of patients reported satisfaction, with a mean Ghanem-Seringe score of 70.4.
- A high percentage experienced poor results (70 feet), pain (86 feet), stiffness (82 feet), and radiographic abnormalities (93 feet).
- Satisfaction correlated with perceived normal gait and initial Dimeglio-Bensahel score, not residual deformity.
Conclusions:
- Extensive soft tissue release for severe clubfoot can lead to long-term morphologic, anatomic, and functional sequelae.
- Patient satisfaction is achievable despite imperfect anatomical results, emphasizing functional perception.
- Female patients reported lower satisfaction due to social constraints and calf atrophy, indicating gender-specific considerations.
Background:
The purpose of this study was to determine the long-term results, at an average follow-up of 22 years, in 66 patients (105 clubfeet) with very severe congenital idiopathic clubfeet according to the Dimeglio-Bensahel scale.
Methods:
Patients were treated with an extensive soft tissue release in infancy. Results of the treatment were assessed according to the 100-point system of Ghanem-Seringe. At the latest follow-up, all participants were evaluated with regard to pain and the overall function of the lower extremities. At the latest follow-up, anteroposterior and lateral radiographs of the affected foot and the contralateral normal foot, when applicable, were performed.
Results:
In total, 92% of the patients were satisfied. The mean functional score of Ghanem-Seringe was 70.4 points. No foot had an excellent result, 19 feet had a good result, 16 had a fair result, and 70 had a poor result. A total of 86 feet were painful after strenuous activities or during walking. Eleven patients walked with a limp. In total, 82 feet were stiff. Ankle dorsiflexion and plantar flexion averaged 4.0±4.5 degrees and 19.9±10.7 degrees. Bone deformations such as flattening of the talar dome were observed in 93 feet. Among these feet, the Ghanem score was significantly lower (P<0.05). Necrosis of the navicular was present in 28 feet and subluxation in 82 feet. In total, 32 feet had moderate osteoarthritis.
Discussion:
Results revealed that despite anatomically and radiologically imperfect clubfeet, most patients demonstrated satisfaction. Satisfaction was not significantly correlated with residual deformity, but with the sensation of a normal gait by the patient and the high initial Dimeglio-Bensahel score. Female patients were significantly less satisfied than male patients because they were more constrained in their social life than boys. Their main dissatisfaction was the atrophy of the calf. We noted several residual deformations. Plantar release seems to contribute to the high rate of overcorrection in our series. Extensive posterolateral and plantar releases in very severe clubfeet was responsible for sequelae, morphologic, anatomic, and functional, especially in adulthood. Deterioration of results over time was confirmed by our series.
Level Of Evidence:
Level IV.
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