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Management of the resistant idiopathic clubfoot: the Kaiser experience from 1980-1990
T J Blakeslee1, S J DeValentine
1Department of Orthopedic Surgery, Kaiser Permanente Medical Center, South Sacramento, California, USA.
Insights
This study evaluated 63 congenital idiopathic clubfeet after posteromedial release surgery. While 95% of parents were satisfied, significant residual deformities and radiographic complications were observed, impacting long-term outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Congenital Deformities
Background:
- Congenital idiopathic clubfoot is a common pediatric orthopedic condition requiring surgical intervention.
- The Turco-type complete posteromedial soft tissue release is a widely used surgical technique.
- Evaluating long-term outcomes and complications is crucial for optimizing treatment strategies.
Purpose of the Study:
- To assess the clinical and radiographic outcomes of congenital idiopathic clubfeet treated with Turco-type posteromedial release.
- To evaluate patient and parent satisfaction following surgical correction.
- To identify the incidence and types of residual deformities and radiographic complications.
Main Methods:
- Clinical and radiographic evaluation of 63 congenital idiopathic clubfeet post-Turco-type surgery.
- Average age at surgery: 12.4 months; average follow-up: 67.2 months.
- Utilized a novel rating system emphasizing dynamic functional results.
Main Results:
- Excellent/good results achieved in 70% of cases based on the new rating system.
- High parent satisfaction (95%), but 59% anticipated future physical limitations.
- Common residual deformities included forefoot adductus (41.3%) and cavus (22.2%).
- Radiographic complications noted: avascular necrosis (14.3%), talar dome flattening (52.4%), and navicular subluxation (34.9%).
Conclusions:
- Turco-type posteromedial release yields high parent satisfaction but is associated with notable residual deformities and radiographic issues.
- The observed complications, particularly cavus and forefoot adductus, warrant attention in surgical planning and postoperative management.
- Further research is needed to refine surgical techniques and improve long-term functional outcomes in clubfoot treatment.
Abstract:
Sixty-three congenital idiopathic clubfeet were clinically and radiographically evaluated following a single Turco-type complete posteromedial soft tissue release with internal fixation. Average age at the time of surgery: 12.4 months; average postoperative follow-up: 67.2 months. A new rating system that weighs dynamic functional results more heavily was used to compare our findings. The results were rated as excellent in 29 feet (46%), good in 15 feet (24%), fair in 8 feet (13%), and poor/failures in 11 feet (17%). Ninety-five percent of the parents were satisfied with the current results, although 59% felt that their child would have physical limitations in the future. Clinical complications included the following residual deformities: hindfoot varus (3.2% or two feet), equinus (3.2% or two feet), cavus (22.2% or 14 feet), and forefoot adductus (41.3% or 26 feet). The bimalleolar axis in the 63 clubfeet averaged 74.9 degrees. No calcaneus gaits were present. Radiographic complications included both over-correction (1.6% or one foot) and under-correction (4.8% or three feet) of the talonavicular joint articulation, avascular necrosis of the navicular, (14.3% or nine feet), talus (4.8% or three feet), and calcaneus (1.6% or one foot). Thirty-three feet (52.4%) revealed some degree of abnormal talar dome flattening, 22 feet (34.9%) revealed navicular dorsal subluxation or "wedging." Only 37 (58.7%) exhibited normal talonavicular joint congruity.