Double column osteotomy for correction of residual adduction deformity in idiopathic clubfoot

Abstract

INTRODUCTION Adduction of the forefoot is the most common residual deformity in idiopathic clubfoot. The 'bean-shaped foot', which is a term used to describe a clinical deformity of forefoot adduction and midfoot supination, is not uncommonly seen in resistant clubfoot. SUBJECTS AND METHODS Fifteen children (20 feet) with residual forefoot adduction in idiopathic clubfeet aged 3-7 years were analyzed clinically and radiographically. All of the cases were treated by double column osteotomy (closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy) with soft tissue releases (plantar fasciotomy and abductor hallucis release), to correct adduction, supination and cavus deformities. Pre-operative measurements of certain foot angles were compared with their corresponding postoperative values. RESULTS A grading system for evaluation of the results using a point scoring system was suggested to evaluate accurately both clinical and radiographic results after a follow-up period of an average of 2.3 years. Eight feet (40%) had excellent, eight (40%) good, three (15%) fair, and one (5%) poor outcome. There was no major complication. There was significant improvement in the result (P > 0.04). CONCLUSIONS Double column osteotomy can be considered superior to other types of bone surgeries in correction of residual adduction, cavus and rotational deformities in idiopathic clubfoot.

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

“…Sometimes the cuboid bone is too soft or too small for the length of the medial column to be corrected. Moreover, as in other lengthening procedures, mobilization of the bone wedge has been reported and requires revision surgery [24,30,46]. External fixation has been proposed to address stiff neglected clubfoot by progressive deformity correction during growth of the child [13,27]; however, dedicated expertise, costs, and difficult care of the patient with an external fixator make this approach unsuitable in a rural context.…”

“…Moreover, the excised cuboid bone is sometimes soft or the wedge is too small to support the needed lengthening of the medial cuneiform. Finally, graft wedge extrusion after the medial cuneiform elongation osteotomy can complicate this approach and require revision surgery [24,30]. To overcome such problems in children older than 5 years with neglected clubfoot, we describe an approach consisting of a single-step combination of a modified STR with the addition of a cuboid subtraction wedge osteotomy.…”

Double Column Foot Osteotomy to Correct Flexible Valgus Foot Deformity in Children with Spastic Cerebral Palsy

“…Foot pain accompanies the foot deformity and results from midfoot break with prominant talar head in the weightbearing part of the foot [11,13]. Radiographically, there is increase in the anterior talocalcaneal Kite's angle, talonavicular angle, talonavicular coverage angle, anterior talo-first metatarsal angle, lateral talocalcaneal angle and lateral talo-first metatarsal Meary's angle [14][15][16][17][18]. A short stride length and low velocity are also observed owing to spasticity, which also causes a reduced step length.…”

Functional Results after Surgical Correction of Neglected and Relapsed Clubfeet

“…The only issue in this premise is that the aim of deformity correction in clubfoot is to achieve a plantigrade foot and not a normal foot. It has been our experience that radiograph of the so-called normal side in a unilateral clubfoot demonstrate a wide variation in the values of the angles measured (21) . The FRS score by Laaveg and Ponseti relies on the patient's satisfaction with the treatment rendered and the response thereof.…”