Calcaneocuboid arthrodesis for recurrent clubfeet: what is the outcome at 17-year follow-up?
Calcaneocuboid arthrodesis was used during revision clubfoot surgery in order to maintain midfoot correction. The purposes of this study were to determine: (1) functional level at 17-year follow-up compared to 5-year follow-up; (2) patients’ current functional level, satisfaction, and pain; and (3) current arthropometric measurements.
Twenty patients (27 clubfeet) with clubfoot relapse underwent revision soft tissue release and calcaneocuboid fusion between 1991 and 1994. They were previously evaluated at a mean follow-up of 5.5 years. Ten out of 20 patients (13 clubfeet), mean age of 24 years, were reevaluated at mean follow-up of 17.5 years. The Hospital for Joint Diseases Functional Rating System (HJD FRS) for clubfoot surgery, Outcome Evaluation in Clubfoot developed by the International Clubfoot Study Group, the Clubfoot Disease-Specific Instrument, American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Outcomes Questionnaire, Laaveg and Ponseti’s functional rating system for clubfoot and pain scale were completed by patient and/or surgeon to assess function, patient satisfaction and pain. Foot and ankle radiographs and anthropometric measurements were reviewed. For HJD FRS, scores from original follow-up were compared to current ones.
The HJD FRS score of all feet was 65.9, demonstrating a significant decline from the original mean score of 77.8 (p = 0.03). Excellent/good HJD FRS scores went from 85 to 38 %. Mean AAOS Foot Ankle Outcomes Questionnaire standardized core and shoe comfort scores were 84.6 and 84.5, respectively. Average foot pain was 1.8 on a scale of 1–10. Patients were very/somewhat satisfied with status of foot in 76 % of feet and appearance of foot in 46 % of feet, based on Clubfoot Disease-Specific Instrument questions.
Revision clubfoot surgery with calcaneocuboid fusion in patients 5–8 years of age showed an expected decline in functional outcome measures over a 17-year follow-up period. It still produced comparable results to other studies for a similar population of difficult, revision cases, and should have a place in current surgical treatment techniques.
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- Calcaneocuboid arthrodesis for recurrent clubfeet: what is the outcome at 17-year follow-up?
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Journal of Children's Orthopaedics
Volume 8, Issue 1 , pp 43-48
- Cover Date
- Print ISSN
- Online ISSN
- Springer Berlin Heidelberg
- Additional Links
- Recurrent clubfoot
- Calcaneocuboid arthrodesis
- Dillwyn Evans procedure
- Author Affiliations
- 1. New York Ponseti Clubfoot Center, Pediatric Orthopaedic Surgery, New York University Langone Medical Center, New York University Hospital for Joint Diseases, 301 East 17th street, 10003, New York, NY, USA
- 2. Department of Orthopaedic Surgery, Soroka Medical Center, Ben Gurion University, Beer Sheva, Israel