Tarsal decancellation in the residual resistant arthrogrypotic clubfoot.
BACKGROUND
Conservatism is well recognised after Ponseti's method in the treatment of congenital clubfoot; however, this is not applicable to the complex and resistant arthrogrypotic type which challenges the orthopaedic surgeon. In such a type, soft tissue releases as fasciotomies,  tenotomies, and capsulotomies, as well as osteotomies are insufficient, and joint fusions are not suitable in early childhood before skeletal maturity.


METHODS
Twelve children (15 feet) with residual resistant arthrogrypotic clubfeet between 2-4 years of age were analysed  clinically and radiographically. All of the cases received previous conservative Ponseti's method of treatment in their first year of life followed by soft tissue releases (plantar fasciotomy, posteromedial tenotomies, capsulotomies, and abductor hallucis release) before treatment by decancellation  of the cuboid, the calcaneus, and the talus to correct the complex adduction, supination, varus, and equinus deformities. Pre-operative measurements of certain foot angles were compared with their corresponding postoperative values.


RESULTS
A grading scheme 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 3.3 years. Six feet (40%) had excellent, six (40%) good, three (20%) fair, and no poor (0%) outcome. There was no major complication. There was  significant improvement in the result (P > 0.035).


CONCLUSIONS
Tarsal decancellation is particularly applicable to residual resistant clubfoot such as the arthrogrypotic type at an early age. It shortens the period of disability, improves the range of foot motion, and does not  interfere with the foot bone growth.
Department of Orthopaedics, National Institute of Neuromotor System, Imbaba, Giza, Egypt.
Hany N
HN
Iskandar
Sherif N G
SN
Bishay
Hatem Abdel-Rahman
HA
Sharaf-El-Deen
Mohsen Mohammad
MM
El-Sayed
D001176:Arthrogryposis / Q000000981:diagnostic imaging / Q000601:surgery*; D002111:Calcaneus / Q000000981:diagnostic imaging; D002675:Child, Preschool; D002908:Chronic Disease; D003025:Clubfoot / Q000000981:diagnostic imaging / Q000601:surgery*; D003646:Debridement / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D010808:Physical Examination / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D013484:Supination / Q000502:physiology; D013639:Tarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology