title: Double column osteotomy for correction of residual adduction deformity in idiopathic clubfoot.
abstract: BACKGROUND
  Adduction of the forefoot is the most common residual deformity in idiopathic clubfoot. The 'bean-shaped foot', which is a term used to describe a clinical deformity of forefoot adduction and midfoot supination, is not uncommonly seen in resistant clubfoot.
  
  
  METHODS
  Fifteen children (20 feet) with residual forefoot adduction in idiopathic clubfeet aged 3-7 years were analyzed clinically and radiographically. All of the cases were treated by double column osteotomy (closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy) with soft tissue releases (plantar fasciotomy and abductor hallucis release), to correct adduction, supination and cavus deformities. Pre-operative measurements of certain foot angles were compared with their corresponding postoperative values.
  
  
  RESULTS
  A grading system for evaluation of the results using a point scoring system was suggested to evaluate accurately both clinical and radiographic results after a follow-up period of an average of 2.3 years. Eight feet (40%) had excellent, eight (40%) good, three (15%) fair, and one (5%) poor outcome. There was no major complication. There was significant improvement in the result (P > 0.04).
  
  
  CONCLUSIONS
  Double column osteotomy can be considered superior to other types of bone surgeries in correction of residual adduction, cavus and rotational deformities in idiopathic clubfoot.
authors.affiliation: Department of Orthopaedics, National Institute of Neuromotor System, Imbaba, Giza, Egypt.
authors.forename: Michel Eshak
authors.initials: ME
authors.lastname: Loza
authors.forename: Sherif N G
authors.initials: SN
authors.lastname: Bishay
authors.forename: Hassan Magdy
authors.initials: HM
authors.lastname: El-Barbary
authors.forename: Atef Abdel-Aziz Zaki
authors.initials: AA
authors.lastname: Hanna
authors.forename: Yehia Nour El-Din
authors.initials: YN
authors.lastname: Tarraf
authors.forename: Ashraf Adel Ibrahim
authors.initials: AA
authors.lastname: Lotfy
mesh_terms: D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011859:Radiography; D012086:Reoperation / Q000379:methods; D012737:Sex Factors; D013639:Tarsal Bones / Q000601:surgery; D016896:Treatment Outcome