Combined double tarsal wedge osteotomy and transcuneiform osteotomy for correction of resistant clubfoot deformity (the “bean-shaped” foot)

Abstract

PurposeThe “bean-shaped foot” exhibits forefoot adduction and midfoot supination, which interfere with function because of poor foot placement. The purpose of the study is a retrospective evaluation of patients who underwent a combined double tarsal wedge osteotomy and transcuneiform osteotomy to correct such a deformity.MethodsTwenty-seven children with 35 idiopathic clubfeet were treated surgically by combined double tarsal wedge osteotomy (closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy) and transcuneiform osteotomy between 2008 and 2012. The age of children at surgery ranged from 4 to 9 years. There were 19 boys and 8 girls. Pre- and postoperative X-rays were used, considering: on the AP radiograph, the calcaneo-fifth metatarsal angle and the talo-first metatarsal angle (indicators of forefoot adduction); on the lateral radiograph, the talo-first metatarsal angle (an indication of supination deformity) and calcaneo-first metatarsal angles (an indication of cavus deformity). These radiological parameters were compared with the clinical results.ResultsFollow-up was conducted for 24–79 months following surgery. Clinical and radiographic improvements in forefoot position were achieved in all cases. An average improvement in the anteroposterior talo-first metatarsal angle of 21°, calcaneo-fifth metatarsal angle of 14°, lateral talo-first metatarsal angle of 10°, and lateral calcaneo-first metatarsal of 12° confirmed the clinically satisfactory correction in all feet. One patient had a wound infection postoperatively, which resolved with removal of the wires and administration of oral antibiotics. Eight patients followed up for more than 5 years had no deterioration of results.ConclusionsCombined double tarsal wedge osteotomy as well as transcuneiform osteotomy is an effective and safe procedure for lasting correction of the bean-shaped foot.

Congenital idiopathic talipes equinovarus before and after walking age: observations and strategy of treatment from a series of 88 cases

“…Therefore, extensive surgery is often required to obtain adequate correction in these cases [ 9 – 13 ]. Different surgical techniques have been advocated for the treatment of unreducible congenital clubfoot, including soft-tissue release, tenotomy and tendon elongation and transfer, joint release, osteotomy and joint fusion; however, the choice of correct surgical procedure for each case is still a cause of concern [ 14 – 16 ]. Moreover, the optimal timing for surgery still remains controversial, although some authors suggest surgery within the first year of life, just before the child starts to walk [ 17 ].…”

What is new in idiopathic clubfoot?

“…The authors noted significant improvement in the sagittal and coronal alignment on follow-up radiographs. Clinical and functional results were not well described, however [52].…”

Complex foot deformities associated with lower limb deformities: a new therapeutic strategy for simultaneous correction using Ilizarov procedure together with osteotomy and soft tissue release

“…A large number of studies reporting various efforts in regard of surgical correction, including soft tissue release, muscular balance [4,5], various osteotomies [6][7][8]or arthrodesis [9], have been published in the past decades. However, the complex foot deformity does not only in uence the foot and ankle region alone.…”