Scleroderma of the foot: orthopaedic treatment

Four patients with scleroderma involving the feet have been treated at Childrens Hospital of Los Angeles by the authors. All children had severe deformity of the feet secondary to the scleroderma. A review of the literature reveals little past mention of indications or treatments of this deformity in the past with the exception of the use of local steroids. Six feet in four children underwent orthopedic treatment. Treatment was primarily by casting to stretch soft tissues and gain as much correction as possible. Surgical correction of the remaining deformity by releasing the soft tissue contractures was then accomplished. Internal fixation of the foot in the corrected position was carried out in four cases. Three of the four patients showed significant improvement following soft tissue surgery and one patient was unchanged. Surgical treatment of the patient with scleroderma can be carried out safely as long as careful attention is paid to circulatory status and extensive preoperative casting and stretching of "soft" tissues is utilized.