title: Factors predicting the outcome of primary clubfoot surgery.
abstract: BACKGROUND
  We aimed to determine the rate of further surgery, the functional outcome and the factors associated with outcome after primary clubfoot surgery.
  
  
  METHODS
  We conducted a retrospective study of a cohort of all children who were less than 2 years of age at the time of surgery for idiopathic clubfoot deformity at the Hospital for Sick Children, Toronto, Ont., a tertiary care pediatric hospital. Of the 91 families who could be contacted, 63 agreed to return. The children's charts were reviewed, and their feet were given a Functional Rating System (FRS) score.
  
  
  RESULTS
  Of the original operated population (n = 126), 75% were male and 41% had bilateral clubfoot. The average age at the time of surgery was 8 months, and the mean follow-up was 80.6 months. Further surgery was performed in 19% of cases. The mean FRS outcome score was 79. On average, the FRS score increased by 1.9 points as age at the time of surgery increased by 1 month. Only the presurgical talocalcaneal index was associated with the need for further surgery.
  
  
  CONCLUSIONS
  The need for further surgery was 19% overall. Children who had surgery closer to 12 months of age had better functional results. Therefore, surgery should probably be performed in the second, rather than the first, 6 months of life.
authors.affiliation: Hospital for Sick Children, Toronto, ON.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Templeton
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Flowers
authors.forename: Kevin H
authors.initials: KH
authors.lastname: Latz
authors.forename: Derek
authors.initials: D
authors.lastname: Stephens
authors.forename: William G
authors.initials: WG
authors.lastname: Cole
authors.forename: James G
authors.initials: JG
authors.lastname: Wright
mesh_terms: D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome