Surgical treatment of clubfoot deformity in arthrogryposis multiplex congenita

Clubfoot deformity in arthrogrypotic patients is difficult to correct, and its recurrence rate is high. We retrospectively reviewed 37 clubfeet in 20 patients with arthrogryposis multiplex congenita who were treated from 1984 to 1993. There were 11 males and nine females. Bilateral involvement was seen in 17 patients and unilateral involvement in three. The mean age at the initial surgery was 2.5 years (range 4 mo to 25 yr). Soft tissue release alone was performed on 33 feet. Primary talectomy was done on both feet of one other patient. The remaining patient (two feet) underwent triple arthrodesis. Recurrence or residual deformities were seen in 18 feet with soft tissue release, among which 12 feet underwent secondary surgeries including soft tissue release, osteotomy, talectomy and connection with Ilizarov apparatus. After the secondary surgery, four of the 12 feet still had deformities. One foot had a third surgery. Achilles tendon lengthening and osteotomy. Twenty-six feet were rated as having good results (plantigrade, painless and without obvious deformity), seven were rated fair (residual deformity requiring secondary procedures) and four had poor results (persistance or recurrence of clubfoot). Despite a high recurrence rate, clubfoot deformity in arthrogrypotic patients can be treated first with radical soft tissue release when the patient is less than 1 year of age. If the foot deformity is persistant or recurs, talectomy can achieve a plantigrade foot. Triple arthrodesis should be reserved for patients with a mature bony structure.