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Evaluation of a surgical treatment algorithm for neglected clubfoot in low-resource settings
Manon Pigeolet1, Saiful Imam2, Gheorghe Cristian Ninulescu3,4
1Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium. Manon.pigeolet@outlook.com.
Insights
Surgical treatment for neglected clubfoot in rural Bangladesh yielded good functional outcomes. Posteromedial release (PMR) surgery showed excellent results, regardless of patient age, enabling normal shoe wear and school/work attendance.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Global health
Background:
- Idiopathic clubfoot is a common congenital condition, disproportionately affecting infants in low- and middle-income countries (LMICs).
- Neglected clubfoot presents significant functional and social challenges in resource-limited settings.
- Effective surgical strategies are crucial for improving outcomes in these populations.
Purpose of the Study:
- To evaluate the morphological, functional, and social outcomes of surgical interventions for neglected clubfoot in rural Bangladesh.
- To assess the efficacy of a specific surgical algorithm in a LMIC context.
- To determine the long-term results of treating neglected clubfoot in children and young adults.
Main Methods:
- Retrospective analysis of 22 patients (32 clubfeet) aged 2-24 years with neglected clubfoot.
- Surgical treatment followed an algorithm: posteromedial release (PMR) +/- soft tissue intervention (Group 1), PMR + bony intervention (Group 2), or triple arthrodesis (Group 3).
- Outcomes assessed using modified International Clubfoot Study Group score and Laaveg-Ponseti score at 2-year follow-up.
Main Results:
- 81% (Group 1) and 80% (Group 2) achieved excellent, good, or fair Laaveg-Ponseti scores; Group 3 had 0% (p=0.0038).
- Age at intervention showed an inverse correlation with the 2-year Laaveg-Ponseti score (p<0.0001).
- All patients could wear normal shoes and attended school or work, indicating good functional and social reintegration.
Conclusions:
- A posteromedial release (PMR) surgical approach, even in older patients, yields good functional outcomes for neglected clubfoot.
- The study's pragmatic surgical algorithm is suitable for LMIC settings.
- Further research is recommended to clarify the role of triple arthrodesis in neglected clubfoot management.
Purpose:
Idiopathic clubfoot affects approximately 1/1000 alive-born infants, of whom 80-91% are born in low- or middle-income countries (LMICs). This retrospective study aimed to evaluate the morphological, functional, and social outcomes in patients with neglected clubfoot in rural Bangladesh, after receiving surgical treatment.
Methods:
Patients received a posteromedial release (PMR) with or without an additional soft tissue intervention (group 1), a PMR with an additional bony intervention (group 2), or a triple arthrodesis (group 3) according to our surgical algorithm. Patients were followed until two year post-intervention. Evaluation was done using a modified International Clubfoot Study Group Outcome evaluation score and the Laaveg-Ponseti score.
Results:
Twenty-two patients with 32 neglected clubfeet (ages 2-24 years) received surgical treatment. Nineteen patients with 29 clubfeet attended follow-up. At two year follow-up an excellent, good, or fair Laaveg-Ponseti score was obtained in 81% (group 1), 80% (group 2), and 0% (group 3) of the patients (p value 0.0038). Age at intervention is inversely correlated with the Laaveg-Ponseti score at two year follow-up (p < 0.0001). All patients attended school or work and were able to wear normal shoes.
Conclusion:
Our treatment algorithm is in line with other surgical algorithms used in LMICs. Our data reconfirms that excellent results can be obtained with a PMR regardless of age. Our algorithm follows a pragmatic approach that takes into account the reality on the ground in many LMICs. Good functional outcomes can be achieved with PMR for neglected clubfoot. Further research is needed to investigate the possible role of triple arthrodesis.
