Clinical Orthopaedics and Related Research®

, Volume 471, Issue 8, pp 2658–2665

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

  • Cesare Faldini
  • Francesco Traina
  • Alberto Di Martino
  • Matteo Nanni
  • Francesco Acri
Clinical Research

DOI: 10.1007/s11999-013-2977-8

Cite this article as:
Faldini, C., Traina, F., Di Martino, A. et al. Clin Orthop Relat Res (2013) 471: 2658. doi:10.1007/s11999-013-2977-8

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.

Supplementary material

Supplementary material 1 (WMV 69874 kb)

Supplementary material 2 (WMV 58436 kb)

Supplementary material 3 (WMV 29302 kb)

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Cesare Faldini
    • 1
  • Francesco Traina
    • 1
  • Alberto Di Martino
    • 1
    • 2
  • Matteo Nanni
    • 1
  • Francesco Acri
    • 1
  1. 1.Department of Rizzoli-Sicilia, Orthopaedic ServiceThe Rizzoli InstituteBagheriaItaly
  2. 2.Department of Orthopaedics and Trauma Surgery, CIR–Center of Integrated ResearchUniversity Campus Bio-Medico of RomeRomeItaly

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