Subtalar release in clubfeet: a retrospective study of 10-year outcomes.
BACKGROUND
Optimal management of congenital talipes equinovarus continues to be controversial. There is a dramatically renewed emphasis on non-operative management partly because there has been a high recurrence rate among operated feet. Our hypothesis is that early, extensive subtalar ligament release as the cornerstone of aggressive hindfoot realignment prevents recurrence and retains mobility.


METHODS
Twenty-two congenital clubfeet (14 patients) corrected by one surgeon were evaluated using two validated patient-based outcome instruments, dynamic pedobarographic analysis, hindfoot mobility, and weightbearing radiographs. Pedobarographic analysis consisted of quantifying peak plantar forces and pressures during the gait cycle in 22 corrected feet and 24 control feet using the FSCAN in-shoe device.


RESULTS
The mean age at surgery was 8 months and mean followup was 10 years. No patients experienced recurrence of deformity. Reported foot function and satisfaction were very high for all patients and were comparable to reported normal population values. AP and lateral talocalcaneal angles for each foot were within normal limits for age. Hindfoot range of motion, including dorsiflexion, was preserved in all feet. Peak regional forces throughout the gait cycle and plantar pressures at foot flat were mildly, but statistically significantly, higher in the midfoot of corrected feet suggesting slight flattening of the arch. One patient had tendon transfers for bilateral calcaneal deformity and one patient had surgical correction of a bilateral valgus deformity.


CONCLUSIONS
Aggressive hindfoot realignment provides definitive treatment of an equinovarus deformity, but care must be taken to avoid overcorrection.
Henn
R Frank
RF
Providence, RI, USA.
Crawford
Dennis C
DC
Eberson
Craig P
CP
Ehrlich
Michael G
MG
D002675:Child, Preschool; D003025:Clubfoot / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D005684:Gait; D006801:Humans; D007223:Infant; D008297:Male; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D055502:Secondary Prevention; D013380:Subtalar Joint / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D016474:Weight-Bearing