Follow-up examinations: 30 years of Imhäuser clubfoot treatment

The author describes his own methods of clubfoot treatment used over 30 years on more than 2,000 children. Correction of form and restoration of function are the two goals of the orthopaedic surgeon. Early treatment consists of closed reduction of forefoot deformity and of varus of the heel, and of operative correction of equinus deformity. Function is restored by a training program developed and introduced by the author for evertors and dorsiflexor muscles. Treatment starting at a later age must take into consideration that in the course of time increasing deformity of all bones and joints as well as marked alterations of soft tissues occur. In these cases closed measures are ineffective and operative measures necessary. After straightening the foot operatively, it is necessary to maintain the normalized position by means of an exterior removable plastic cast until the translocated tibialis anterior muscle can fulfil this task. The later the clubfoot is treated, the longer the period for which these casts are required. The author reexamined nearly 400 feet of adults whom he had treated during their baby or childhood years. The late results of three groups are demonstrated: (a) cases treated before the age of 2; (b) cases treated between 2 and 7 years; (c) cases treated at the age of 7 years or later. Good late results were observed in a surprisingly high percentage of the cases. The author's method--based on a pathophysiological approach--seems to represent real progress in the treatment of idiopathic clubfeet.