Talipes Equinovarus surgical Management after Failure of Ponseti Technique in Children

Abstract

Background: Conservative approaches as Ponseti Technique in managing Talipes Equinovarus could lead to various serious consequences, surgical treatment could if necessary. Objective: The aim of the work was to assess the functional and radiological outcome of surgically treated clubfeet after failure of Ponseti technique in children. Patients and Methods: Twelve clubfeet in twelve patients were undergoing posterior medial release in this prospective study at the Orthopedic Department, Zagazig University Hospitals during the period from November 2020 to the end of August 2021 and followed up in out-patients clinics, follow-up period from three to six months. The selected cases were thoroughly examined clinically and radiologically pre-and postoperative. Results: All postoperative cases were plantigrade; with no poor results were noticed. most cases (81.25%) were with excellent to good results while the remaining (18.75%) were fair with plantigrade foot. Lateral talocalcaneal angle was 12.75±4.65° before surgery; and changed after posterior medial release 40.83±4.37°. The increase was significant (P<0.001). Anteroposterior talo-first metatarsal angle was also with significant change from pre to after posterior medial release (P<0.001). As regard complications, there were intraoperative bleeding (two patients) as well as postoperative infections (one patient) and plaster sores and dermatitis (four patients). Conclusion:It could be concluded that in failed Ponseti technique there is adhesion under the skin of the distal tibia and there is adhesion and fibrosis around the incision of the tendon Achilles certain point should be fulfilled to obtain complete reduction and anatomical restoration of the foot after failed Ponseti.