Skip to main content
SpringerLink
Log in

Limitation of flatfoot surgery in overcorrected clubfeet after extensive surgery

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Flatfoot is a severe complication of extensive clubfoot surgery. In this retrospective study, we evaluated our results following flatfoot surgery in overcorrected clubfeet. The aim was to analyze the success of different surgical techniques, including tarsal osteotomies and arthrodesis, in correcting different types of flatfeet.

Material and method

Between January 1, 2011 and December 31, 2015 we treated 25 severe cases of flatfeet after extensive clubfoot surgery. We classified the hindfoot deformities into rotational valgus, hinge valgus or translatory valgus based on AP standing X-rays. Tarsal osteotomies (Mitchell, Evans, Cotton) and arthrodesis were adapted based on age and severity. Age, gender, pain, hindfoot valgus and function were documented. Function and X-rays were compared pre- and postoperatively.

Results

There were 17 male and 4 female patients. Age at operation ranged from 11 to 26 years with an average age of 14.3 years. The mean follow-up was 27.6 months (7–60 months). Primary surgical treatment was a tarsal osteotomy in 19 cases and in six cases it was arthrodesis. Hindfoot valgus (Ø 18.6°–3.2°), calcaneal pitch (Ø 6.2°–14.6°), Costa Bartani angle (Ø155°–142°) and Meary angle (Ø 2.0°–8.8°) improved pre- to postoperatively. Range of motion did not improve after surgical correction. 81% were satisfied with the postoperative results. All flatfeet with translatory valgus, initially treated with a tarsal osteotomy, needed further arthrodesis due to primary undercorrection.

Conclusion

Tarsal osteotomies are successful methods for correcting flatfeet following extensive clubfoot surgery with rotational valgus and mild hinge valgus. Tarsal osteotomies are unable to successfully correct flatfeet that have a translatory valgus. In such cases, we recommend double or triple arthrodesis. The functional outcome is limited by the preop range of motion and the appearance of talus deformities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Simon GW (1985) Complete subtalar release in clubfeet. Part I. A preliminary report. J Bone Joint Surg 76-A:1044–1055

    Article  Google Scholar 

  2. McKay DW (1983) New concept of and approach to clubfoot treatment: section II—correction of the clubfoot. J Pediatr Orthop 3:10–21

    Article  CAS  Google Scholar 

  3. Turco VJ (1997) Resistant congenital clubfoot—one stage posteromedial release with internal fixation: a follow-up report of 15-year experience. J Bone Joint Surg 61:805–814

    Article  Google Scholar 

  4. Dobbs MB, Nunley R, Schoenecker PL (2006) Long-term follow-up of patients with clubfeet treated with extensive soft-tissue release. J Bone Joint Surg Am 88:986–96

    Article  Google Scholar 

  5. Zide JR, Myerson M (2013) The overcorrected clubfoot in the adult: evaluation and management—topical review. Foot Ankle Int 34:1312–1318

    Article  Google Scholar 

  6. Burger A, Aiyer A, Myerson MS (2015) Evaluation and surgical management of the overcorrected clubfoot deformity in the adult patient. Foot Ankle Clin Am 20:587–599

    Article  Google Scholar 

  7. Thompson GH, Abaza H (2010) Clubfoot: Operative treatment. Chapter 6. In: McCarthy JJ, Drennan JC Drennan’s the child’s foot and ankle, 2nd edn. Lippincott, Wiliams & Wilkins

  8. Kuo KN, Smith PA (2009) Correction residual deformity following clubfoot releases. Clin Ortho Rel Res 467:1326–1333

    Article  Google Scholar 

  9. Haslam PG, Goddard M, Flowers MJ, Fernandes JA (2006) Overcorrection and generalized joint laxity in surgically treated congenital talipes equino-varus. J Ped Orthop 15:273–277

    Article  Google Scholar 

  10. Wei SY, Sullivan RJ, Davidson RS (2000) Talo-navicular arthrodesis for residual midfoot deformities of a previously corrected clubfoot. Foot Ankle Int 21:482–485

    Article  CAS  Google Scholar 

  11. Knupp M, Barg A, Bollinger L, Hintermann B (2012) Reconstructive surgery for overcorrected clubfeet in adults. J Bone Joint Surg 94:1001–1007

    Article  Google Scholar 

  12. Yong SM, Smith PA, Kuo KN (2007) Dorsal bunion after clubfoot surgery: outcome of reverse Jones procedure. J Ped Orthop 27:814–880

    Article  Google Scholar 

  13. Boffeli TJ, Schnell KR (2017) Cotton osteotomy in flatfoot reconstruction: a review of consecutive cases. J Foot Ankle Surg 56:990–995

    Article  Google Scholar 

  14. Mosca VS (1995) Calcaneal lengthening for valgus deformity of the hindfoot. Results in children who had severe, symptomatic flatfoot and skewfoot. J Bone Joint Surg 77:500–512

    Article  CAS  Google Scholar 

  15. Mitchell GP (1977) Posterior displacement osteotomy of the calcaneus. J Bone Joint Surg Br 59:233–235

    Article  CAS  Google Scholar 

  16. Atar D, Lehmann WB, Grant AD, Strongwater A (1993) Tarsal navicular position after complete soft-tissue clubfoot release. Clin Orthop Rel Res 295:252–25

    Google Scholar 

  17. Kuo KN, Jansen LD (1998) Rotatory dorsal subluxation of the navicular: a complication of clubfoot surgery. J Ped Orthop 18:770–774

    CAS  Google Scholar 

  18. Schlafly B, Butler JE, Siff SJ, Criswell AR, Cain TE (1985) The appearance of the tarsal navicular after posteromedial release for clubfoot. Foot Ankle 5:222–237

    Article  CAS  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Olgahospital Stuttgart, Kriegsbergstrasse 62, 70174, Stuttgart, Germany

    Oliver Eberhardt, Michael Wachowsky, Thomas Wirth & Francisco Fernandez Fernandez

Authors
  1. Oliver Eberhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Wachowsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Wirth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francisco Fernandez Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Oliver Eberhardt.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal participants rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Eberhardt, O., Wachowsky, M., Wirth, T. et al. Limitation of flatfoot surgery in overcorrected clubfeet after extensive surgery. Arch Orthop Trauma Surg 138, 1037–1043 (2018). https://doi.org/10.1007/s00402-018-2932-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-018-2932-y

Keywords

Search

Navigation