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Can Selective Soft Tissue Release and Cuboid Osteotomy Correct Neglected Clubfoot?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights® to this article was published on 13 June 2013

Abstract

Background

Neglected clubfoot in older children is characterized by a stiff, nonreducible deformity with relative elongation of the lateral column of the foot with respect to the medial column. Surgical correction often has involved a double osteotomy with elongation of the medial column and shortening of the lateral column, or the use of an external fixator to achieve more gradual correction. Both approaches have shortcomings.

Questions/purposes

We therefore (1) used objective physical examination measurements and a functional assessment to evaluate the effectiveness of cuboid osteotomy combined with a selective soft tissue release to achieve correction of neglected clubfoot in older children, (2) determined the rate of complications, and (3) ascertained whether the initial correction achieved was maintained.

Methods

We reviewed 31 patients (56 feet) older than 5 years with severe, neglected nonreducible clubfoot deformity who underwent the index procedure. Minimum followup was 2 years (average, 6 years; range, 2–9 years). Postoperatively, the Laaveg and Ponseti classification and Dimeglio score were used to grade correction. Complication rates were tallied.

Results

According to the Laaveg and Ponseti classification, 24 feet showed excellent correction, 20 good, nine fair, and three poor at 1-year followup. These results were maintained up to the latest followup. Patients showed significant improvement of Dimeglio score after surgery (p < 0.0001). Two patients had postoperative skin-related complications that healed without additional surgery.

Conclusions

Cuboid subtraction osteotomy combined with posteromedial release is an effective approach to manage a stiff nonreducible neglected clubfoot deformity in older children.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Fig. 2A–G

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Acknowledgments

We thank Prof. Alessandro Faldini and Prof. Sandro Giannini for their invaluable teaching of surgery of the severe deformities of the foot; moreover we thank all the volunteers involved in the Orthopaedics Onlus operating at the Mlali Children Hospital and in other centers in Africa. We also thank Stavroula Pagkrati for the drawings included in this manuscript.

Author information

Authors and Affiliations

  1. Department of Rizzoli-Sicilia, Orthopaedic Service, The Rizzoli Institute, Bagheria, Italy

    Cesare Faldini MD, Francesco Traina MD, Alberto Di Martino MD, PhD, Matteo Nanni MD & Francesco Acri MD

  2. Department of Orthopaedics and Trauma Surgery, CIR–Center of Integrated Research, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200–00128, Rome, Italy

    Alberto Di Martino MD, PhD

Authors
  1. Cesare Faldini MD
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  2. Francesco Traina MD
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  3. Alberto Di Martino MD, PhD
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  4. Matteo Nanni MD
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Corresponding author

Correspondence to Alberto Di Martino MD, PhD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patient licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at The Rizzoli Institute (Bagheria, Italy) and University Campus Bio-Medico of Rome (Rome, Italy). Surgery was performed at the Mlali Children Hospital (Kongwa, Tanzania).

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Faldini, C., Traina, F., Di Martino, A. et al. Can Selective Soft Tissue Release and Cuboid Osteotomy Correct Neglected Clubfoot?. Clin Orthop Relat Res 471, 2658–2665 (2013). https://doi.org/10.1007/s11999-013-2977-8

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