Calcaneus gait following treatment for clubfoot: preliminary results of surgical correction.
Calcaneus gait is a known complication of surgical treatment of clubfoot, and is characterized by weak triceps surae strength combined with limited ankle plantarflexion at terminal stance, preventing adequate power generation. We evaluated the results of attempted reconstruction of this functional disturbance in 13 symptomatic patients (17 feet) using kinematic and kinetic analysis at a minimum of 1 year postoperatively. Three types of procedures were performed: group 1 (n=7) received calcaneal osteotomy alone; group 2 (n=6) received calcaneal osteotomy or hindfoot fusion combined with tendon transfers to the heel; and group 3 (n=4) received tendon transfers only. Kinematic results showed that none of the procedures was effective in increasing plantarflexion at toe-off. Kinetic analysis showed that plantarflexion power of group 1 and 2 feet actually worsened following surgery, while in group 3 there was mild improvement. Patients in group 3 were 5 years younger on average than those in groups 1 and 2, suggesting that if any objective benefit from surgery is to be gained, reconstruction should be performed prior to age 6 years. We conclude that calcaneus gait as a complication of clubfoot surgery is far better avoided than salvaged by attempted reconstruction, which in this series was ineffective.
O'Brien
Shana E
SE
Texas Scottish Rite Hospital for Children, Dallas, Texas, USA. charles.johnston@tsrh.org
Karol
Lori A
LA
Johnston
Charles E
CE
D000293:Adolescent; D000842:Ankle / Q000503:physiopathology; D002111:Calcaneus / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000503:physiopathology / Q000601:surgery*; D005684:Gait / Q000502:physiology*; D006801:Humans; D010027:Osteotomy; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013709:Tendon Transfer; D016896:Treatment Outcome