[Results of operative therapy of idiopathic clubfoot using a dorsomedial approach with soft tissue preparation "à la carte"].
BACKGROUND
Several concepts have been published for therapy of idiopathic clubfoot. Actually the Cincinnati approach is the "gold-standard" in operative treatment of idiopathic clubfoot. Using this approach delayed wound healing and overcorrection are wellknown complications. During the last 30 years a dorsomedial approach is used in operative treatment of idiopathic clubfoot in our clinic. Using this approach a dorsal, medial and/or lateral release can be performed. Postoperatively a plaster cast is used. The following years a rigid therapy with orthosis and support is requested.


METHODS
Between June 1986 and December 2000 130 clubfoot operations with soft tissue release were performed. 119/130 (91 %) patients could be clinically and radiologically followed-up after a mean of 4.5 years (min: 2, max: 17) including 65.5 % male and 34.5 % female patients. Average age at time of operation was 7.6 months. The findings were classified according to Dimeglio. To evaluate the clinical results the score according to Laaveg and Ponseti was used. X-rays with load (a. p. and lateral view) were evaluated preoperatively and at follow-up for a. p. and lateral talocalcaneal angle, talometatarsal-I-angle, calcaneometatarsal-V-angle and the angle of the first ray. Additionally complications and recurrences were documented.


RESULTS
21.8 % of the feet were classified IV degrees , 39.5 % III degrees and 38.7 % II degrees according to Dimeglio. Recurrent clubfoot was found in 7.6 % of all cases. All angles showed a significant improve. At latest follow-up 95.6 +/- 9.2 points according to the score of Laaveg and Ponseti were achieved. Flat top talus was found in 37 cases.


CONCLUSIONS
The dorsomedial approach allows an excellent correction of clubfeet with a low rate of complications and recurrences in comparison to other studies.
Schuh
A
A
Abteilung für Kinderorthopädie der Orthopädischen Klinik Wichernhaus, Rummelsberg 71, 90592 Schwarzenbruck, Germany. Schuh-Alexander@t-online.de
Göske
R
R
Salminen
S
S
Zeiler
G
G
Schraml
A
A
D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000601:surgery*; D000293:Adolescent; D000359:Aftercare; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery; D001864:Bone Wires; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008022:Ligaments / Q000601:surgery; D008297:Male; D018482:Muscle, Skeletal / Q000601:surgery; D009989:Orthotic Devices; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011859:Radiography; D013710:Tendons / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome