Forefoot adductus correction in clubfoot deformity with cuboid-cuneiform osteotomy: a retrospective analysis.
BACKGROUND
Forefoot adduction is the most common residual deformity in the treatment of pediatric clubfoot. Little documentation exists regarding its late occurrence and early detection. A retrospective analysis was conducted to determine the effect of primary posterior medial release for idiopathic clubfoot that had failed to improve with conservative treatment or had presented after a treatment delay and a subsequent forefoot adduction correction with a cuboid-cuneiform osteotomy.


METHODS
Radiographic evaluations were conducted of all of the surgical procedures performed at our institution for idiopathic clubfoot during a specified period. Preoperative and postoperative talo-first metatarsal and talocalcaneal angles were measured radiographically. Of 138 patients with clubfoot deformity who met the inclusion criteria, 51 underwent a primary posterior medial release; of these patients, 18 (26 feet) underwent a subsequent cuboid-cuneiform osteotomy.


RESULTS
The average preoperative and postoperative talo-first metatarsal anteroposterior angles for patients who underwent primary posterior medial release were 44.6 degrees and 26.8 degrees , respectively. The mean reduction in forefoot adduction was 17.8 degrees (P < .05). After the osteotomy, the average talo-first metatarsal anteroposterior angle was 16 degrees , with an average reduction of 10.8 degrees (P < .05). Mean follow-up was 61.2 months. The average patient age was 3.2 years.


CONCLUSIONS
Eighteen (35%) of 51 patients who underwent a posterior medial release required a subsequent cuboid-cuneiform osteotomy. The average reduction of 10.8 degrees was statistically significant and has also proved to be clinically significant in the overall correction of the deformity.
Lee
Daniel K
DK
Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA 92103, USA.
Benard
Marc
M
Grumbine
Nicholas
N
Pokrassa
Mitchell
M
Weinstein
Stan
S
D002675:Child, Preschool; D003025:Clubfoot / Q000601:surgery*; D005528:Foot / Q000601:surgery*; D006801:Humans; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D013639:Tarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome