[Long-term results of extensive surgical dissection in the treatment of congenital clubfoot].
OBJECTIVE
We evaluated the long-term functional and radiographic results of patients who underwent extensive soft tissue dissection for the treatment of congenital clubfoot.


METHODS
We retrospectively evaluated 47 feet of 30 patients (6 girls, 24 boys; mean age 9.8 months) who underwent extensive surgical dissection for congenital clubfoot. Involvement was bilateral in 17 patients. Surgical dissection included complete subtalar release (CSTR) in 35 feet, and posteromedial release (PMR) in 12 feet. The mean age was 9.6 months (range 6 to 23 months) in CSTR-, and 10.6 months (range 5 to 23 months) in PMR-treated patients. The patients were assessed with the Laaveg-Ponseti functional score, foot bimalleolar angle, and other radiographic measurements. The mean follow-up was 117.3 months (106.6 months in the CSTR, and 150.6 months in the PMR group).


RESULTS
Functional results were excellent in 24 feet, good in 12 feet, fair in six feet, and poor in five feet. All the poor results were seen in the CSTR group. Of these five feet, two developed recurrences, two had both pes cavus and metatarsus adductus deformities, and one had pes cavus deformity. Considering the foot bimalleolar angle, 83.4% of PMR-treated feet, and 85.7% of CSTR-treated feet were rated as type 1 or 2. Functional scores were significantly correlated with the foot bimalleolar angle, talus-first metatarsus angle on anteroposterior and lateral radiographs, and with the talocalcaneal angle on anteroposterior radiographs (p<0.05). There were no significant differences between the two surgical procedures with respect to functional scores and radiographic measurements (p>0.05).


CONCLUSIONS
Extensive surgical dissection enables simultaneous correction of all components of deformity and provides satisfactory results not only in the short-term but also in the long-term follow-up.
Deniz
Gökmen
G
Department of Orthopedics and Traumatology (1. Ortopedi ve Travmatoloji Kliniği), Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey. drgokmendeniz@yahoo.com
Bombaci
Hasan
H
Tuygun
Hakan
H
Görgeç
Mücahit
M
Köse
Ozkan
O
Yanik
H Serhat
HS
D003025:Clubfoot / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014421:Turkey