title: Combined lateral and transcuneiform without medial osteotomy for residual clubfoot for children.
abstract: Residual deformity in resistant clubfoot is not uncommon. The "bean-shaped foot" exhibits forefoot adduction and midfoot supination and may interfere with function due to poor foot placement. For children less than 5 years of age we describe a corrective procedure combining a closing wedge cuboidal osteotomy and trans-midfoot rotation procedure without a medial opening wedge osteotomy. We retrospectively reviewed twelve patients (14 feet), mean age 4.7 years (range, 4-5 years), who had undergone the procedure to correct forefoot adduction and midfoot supination deformities. We obtained minimal access via a small lateral skin incision. Cuboid lateral wedge osteotomy was followed by transcuneiform osteotomy using a Kirschner wire as a guide under an image intensifier. The minimum followup was 2 years (mean, 2.6 years; range, 2-3.2 years). All patients had qualitative improvement in correction of adduction and supination deformities. Radiographically there was an improvement in adduction deformity, the mean anteroposterior talo-first metatarsal and calcaneo-fifth metatarsal angles improved by 28 degrees (from 40 degrees to 12 degrees ) and by 11 degrees (from 21 degrees to 10 degrees ). The supination improved by 11 degrees (from 19 degrees to 8 degrees ) and the cavus improved by 17 degrees (from 30 degrees to 13 degrees ). The short-term outcome was reliable and this combination is useful for children younger than 5 years old where the medial cuneiform ossification center remained poorly defined.
  
  
  METHODS
  Level IV, therapeutic study (case series). See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, KK Women and Children Hospital, Singapore, Singapore.
authors.forename: Arjandas
authors.initials: A
authors.lastname: Mahadev
authors.forename: Ismail
authors.initials: I
authors.lastname: Munajat
authors.forename: Azura
authors.initials: A
authors.lastname: Mansor
authors.forename: James H P
authors.initials: JH
authors.lastname: Hui
mesh_terms: D002675:Child, Preschool; D003025:Clubfoot / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010027:Osteotomy; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D012399:Rotation; D013639:Tarsal Bones / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome