Osteotomy of the first cuneiform as treatment of residual adduction of the fore part of the foot in club foot.

Hofmann, Aaron A.; Constine, Ronald; McBride, G G; Coleman, Sherman S.

doi:10.2106/00004623-198466070-00003

Cited by 46 publications

(13 citation statements)

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“…Numerous types and combinations of osteotomies have been described to achieve correction of complex deformities in the neglected clubfoot. At first, surgery was aimed at shortening of the lateral column [21] by wedge resection and enucleation of the cuboid, or conversely, at elongating the short medial column by medial wedge cuneiform osteotomy [18]. Later, the combination of medial and lateral osteotomies was described with the aim of addressing the disease at the midfoot and the forefoot [32], together with more complex osteotomies to ease correction of the rotatory component of the deformity [23,39]; all of these were reserved for children older than 4 years where the medial cuneiform ossific nucleus is well developed [14,29].…”

Section: Discussionmentioning

confidence: 99%

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

Faldini¹,

Traina²,

Martino³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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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.

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Section: Discussionmentioning

confidence: 99%

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

Faldini¹,

Traina²,

Martino³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Lichtblau 25 in 1973 suggested a resection of the anterior end of the calcaneus as a method of avoiding this complication. However, this would act on only one of the sides of the deformity, as with procedures that lengthen the medial column described by Fowler 2 in 1959, and 26 in 1984. They described an opening wedge osteotomy of the medial cuneiform but that did not easily address the rotational deformity.…”

Section: Discussionmentioning

confidence: 99%

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

Loza

Bishay

Barbary

et al. 2010

annals

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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.

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“…The opening wedge medial cuneiform osteotomy was originally proposed by Fowler et al [4] for correction of the cavovarus foot. Later the technique was redefined by other authors [8,13] for correction of residual forefoot adduction after congenital clubfoot and metatarsus varus. The combination of two commonly used procedures, opening wedge medial cuneiform osteotomy and closing wedge cuboid osteotomy, addresses the pathology in two planes and thereby effects the desired functional clinical improvement [15].…”

Section: Discussionmentioning

confidence: 99%

Midterm results following revision surgery in clubfeet

Ettl

Kirschner

Krauspe

et al. 2007

International Orthopaedics (SICOT)

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Relapse rates of surgically treated clubfeet are about 25%. We reviewed 43 patients (57 feet) treated for relapsed clubfoot deformity between 1992 and 2001 in our department. The average age of the patients at the time of revision surgery was 5.1 years, the mean follow-up was 6.6 years. Surgical therapy was performed using an algorithm according to age groups. The mean Atar score at follow-up was 77 points, representing a good outcome. Out of 57 feet, 20 (35%) were rated excellent, 24 (42%) good, 5 (9%) fair, and 8 (14%) poor. The number of previous surgical interventions had no influence on the outcome. Using an age related surgical algorithm, good postoperative results could be achieved in most of our patients, thus improving their functional situation. This emphasises the usefulness of the proposed algorithm in the difficult situation of recurrent clubfoot, while thorough analysis of the underlying deformity remains essential.

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Osteotomy of the first cuneiform as treatment of residual adduction of the fore part of the foot in club foot.

Cited by 46 publications

References 0 publications

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

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

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

Midterm results following revision surgery in clubfeet

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