Long-term results of the posteromedial release in the treatment of idiopathic clubfoot.
BACKGROUND
Short-term follow-up studies show good results in foot function, after surgical treatment of idiopathic clubfeet. Long-term follow-up studies are rare and probably represent a mixture of experience of different treating orthopedic surgeons. The purpose of this study is to present the long-term results of the posteromedial release (PMR) in congenital clubfoot treatment of 1 treating surgeon.


METHODS
Thirty-eight patients with 58 clubfeet had an a la carte PMRe, performed by 1 experienced pediatric orthopedic surgeon before the age of 2 years. This group had a mean follow-up of 16 years (range 13 to 24 years). All patients were interviewed and examined. Thereafter, the standing anteroposterior and lateral radiographs of the feet were taken. The results of the treatment were graded according to the system of Laaveg and Ponseti, and with the radiographs the grade of osteoarthritis was determined. The results were compared with the controlateral normal feet.


RESULTS
In 53 feet, the mean rating was 80.6 points (range 43 to 97), according to the system of Laaveg and Ponseti. There were 15 excellent, 17 good, 13 fair, and 8 poor results. The majority of patients had the limitation of foot function with a significant decrease in dorsiflexion of 31% and a significant decrease of pronation-suppination of 24%. The grade of osteoarthritis was consistently higher in the clubfeet than in the controlateral normal feet. Five feet (9%) needed an additional bony procedure because of pain and overcorrection of the clubfeet. This was considered to be a failure of the surgical treatment.


CONCLUSIONS
In our study population, PMR will lead to stiff, and therefore to clinical not fully functional, feet after a follow-up of 16 years.


METHODS
Therapeutic level III.
van Gelder
Janke H
JH
Department of Orthopaedics, University Medical Centre Groningen; University of Groningen, Groningen, the Netherlands.
van Ruiten
Alward G P
AG
Visser
Jan D
JD
Maathuis
Patrick G M
PG
D000293:Adolescent; D003025:Clubfoot / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D010003:Osteoarthritis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D010146:Pain / Q000209:etiology; D011859:Radiography; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult