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Surgical management of clubfoot overcorrection: a case series

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

Abstract

Introduction

Overcorrection is a possible complication of clubfoot treatment, whose prevalence varies from 5 to 67%. Overcorrected clubfoot usually presented as a complex flatfoot with different degrees of hindfoot valgus, flat top talus, dorsal bunion, and dorsal navicular subluxation. The management of clubfoot overcorrection is challenging, and both conservative and surgical treatments are available. This study aims to present our experience in the surgical management of overcorrected clubfoot and to provide an overview of actual treatment options for each specific sub-deformity.

Materials and methods

A retrospective cohort study of patients surgically treated for an overcorrected clubfoot from 2000 to 2015 at our Institution was conducted. Surgical procedures were tailored to the type and symptomatology of the deformity. A medializing calcaneal osteotomy or subtalar arthrodesis was performed for hindfoot valgus. Subtalar and/or midtarsal arthrodesis were considered in cases of dorsal navicular subluxation. The first metatarsus elevatus was addressed through a proximal plantarflexing osteotomy, sometimes associated with a tibialis anterior tendon transfer. Clinical scores and radiographic parameters were obtained pre-operatively and at the last follow-up.

Results

Fifteen consecutive patients were enrolled. The series included 4 females and 11 males, with a mean age at surgery of 33,1 (18–56) years, and a mean follow-up of 4,46 (2–10) years. Seven medializing calcaneal osteotomies, 5 subtalar arthrodesis, 11 first metatarsal plantarflexing osteotomies, and 7 anterior tibialis tendon transfers were performed. A statistically significant improvement in both clinical and radiographic scores was observed.

Conclusions

Management of overcorrected clubfoot involves many surgical techniques because of the high interpersonal variability of the deformities. The surgical approach showed positive results, as long as the indication is based on clinical symptoms and functional impairment rather than morphological alterations and radiographic findings.

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Data availability

The datasets analysed during the current study are available from the corresponding author on reasonable request.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy

    Cesare Faldini, Elena Artioli, Alessandro Panciera, Simone Bonelli, Alberto Arceri & Antonio Mazzotti

  2. Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy

    Cesare Faldini, Alessandro Panciera & Antonio Mazzotti

Authors
  1. Cesare Faldini
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  2. Elena Artioli
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  3. Alessandro Panciera
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  4. Simone Bonelli
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  5. Alberto Arceri
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  6. Antonio Mazzotti
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by AM, AA, and SB. The first draft of the manuscript was written by EA and AP, and all authors commented on previous versions of the manuscript. Conception and supervision were executed by CF. All authors read and approved the final manuscript.

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Correspondence to Antonio Mazzotti.

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Faldini, C., Artioli, E., Panciera, A. et al. Surgical management of clubfoot overcorrection: a case series . Arch Orthop Trauma Surg 143, 6503–6511 (2023). https://doi.org/10.1007/s00402-023-04946-3

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  • DOI: https://doi.org/10.1007/s00402-023-04946-3

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