Complete subtalar release for older children who had recurrent clubfoot deformity

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

“…In many low-income countries, patients with congenital clubfeet present to the physician late, when parents become concerned about their children starting to walk on the deformed feet. At that time, the foot is likely to have become rigid, and typically the child walks with weightbearing on the dorsolateral aspect of the affected foot [5,16]. Although much of the current literature reports the clinical results of treatment for congenital clubfoot in the early years, few reports discuss the results of surgical techniques required to treat the more rigid deformities found in older children [12,24,25].…”

“…Moreover, repeated, soft tissue procedures may result in extensive postoperative scarring, with a high rate of complications such as skin necrosis, infection, or neurovascular damage [22]. Others have proposed a circumferential (Cincinnati) approach for these patients, used to address an extensive release at the posterolateral corner behind the lateral ankle or at the plantar fascia, but with the drawback of potential soft tissue loss that requires fasciocutaneous flaps [16]. We decided to perform two longitudinal incisions, on the posteromedial and lateral side of the foot, and a less extensive STR because of the contribution of the cuboid osteotomy, thus avoiding any additional plastic surgery which was not easy to perform in our clinical setting.…”

Technical details of using sural flap in pes equinovarus surgery: a preliminary report on the technique

“…However, in cases where problems associated with skin closure are avoided, posteromedial release may also be considered as a single-step treatment alternative in severe cases. Local Xaps [2][3][4][5][6][7][8]22], cross Xaps [11], or expanded Xaps [9,10] are used to close skin defects in this region. Rotation Xaps harvested from the leg may be used for closure of skin defects due to PEV [2][3][4][5].…”

“…In the majority of cases, it is successfully treated with serial castings using the Ponseti method [1]. For neglected patients with no previous conservative treatment, complex surgical procedures may be required for correction of this deformity [2][3][4][5][6][7][8][9][10][11]. The main complication of neglected PEV cases is recurrence of the anomaly.…”

Interventions for congenital talipes equinovarus

“…[92][93][94][95][96] Long term follow-up studies have demonstrated that unlike minor surgical procedures (extra-capsular), major surgical procedures (intra-capsular) result in pain, limited range of movement and weakness. [97][98][99] The most common minor surgical procedure is an Achilles tenotomy, while the most common major surgical procedure is a posteromedial soft tissue release.…”