External rotation tibial osteotomy in clubfoot: adverse late effects

In a review of 16 feet in clubfoot patients who had external rotation osteotomies to correct internal tibial torsion, 13 had the undesired effect of aggravating and increasing the varus deformity of the foot. External rotation osteotomy to correct internal tibial torsion seems contraindicated in the presence of clubfoot. If an indication does exist, the chances of late adverse effects can be decreased by deferring surgery until the child is over the age of 8, or by combining the procedure with lengthening of the long flexor tendons.