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Posterolateral release for resistant club foot
1Royal National Orthopaedic Hospital, Stanmore and Charing Cross Hospital, London, England.
Insights
Posterolateral release alone effectively treats idiopathic clubfoot in infants, with most patients showing good long-term function and appearance. However, a significant reoperation rate suggests careful patient selection is crucial for this clubfoot treatment.
Area of Science:
- Pediatric Orthopedics
- Surgical Techniques
- Congenital Foot Deformities
Background:
- Idiopathic clubfoot is a common congenital foot deformity in infants.
- Posterolateral release is a surgical technique used to correct clubfoot.
- The long-term efficacy of posterolateral release alone requires further investigation.
Purpose of the Study:
- To evaluate the long-term functional and aesthetic outcomes of idiopathic club feet treated with posterolateral release alone.
- To determine the reoperation rate and identify factors associated with unsatisfactory results.
Main Methods:
- A cohort of 37 infants (53 idiopathic club feet) underwent posterolateral release at a mean age of 2.4 months.
- Patients were followed for a mean of 10 years and 7 months, with assessment of function and appearance.
- Data collected included ankle dorsiflexion, subtalar joint motion, and need for further surgical intervention.
Main Results:
- Excellent correction of hindfoot equinus was achieved in all cases, with mean ankle dorsiflexion of 15 degrees.
- Subtalar joint motion was 50-75% of normal in most feet.
- Seventeen feet (32%) required further surgery, with poor results in four feet.
Conclusions:
- Posterolateral release alone can provide satisfactory long-term results for idiopathic club feet.
- A significant reoperation rate (32%) suggests that a radical release is not universally necessary.
- Careful patient selection may optimize outcomes and minimize the need for revision surgery in clubfoot management.
Abstract:
We treated 37 infants with 53 idiopathic club feet by posterolateral release alone at a mean age of 2.4 months. They were reviewed after a mean follow-up of 10 years 7 months. Both function and appearance were studied. Seventeen feet had required further surgery, at an average of four years after posterolateral release. In all cases hindfoot equinus had been well corrected; the mean ankle dorsiflexion at review was 15 degrees. Most feet showed subtalar joint movement of between 50% and 75% of normal. Four feet showed poor results: one had a stiff subtalar joint, two feet in one child showed fixed forefoot varus, and one foot had required a Dillwyn-Evans operation at 5.5 years. The overall reoperation rate of 32% at ten years suggests that a radical release operation is not necessary in all patients. Of 59 patients who had only a simple posterolateral release 27 (46%) have satisfactory results.
