title: Reconstructive surgery for overcorrected clubfoot in adults.
abstract: BACKGROUND
  A known complication of the surgical treatment of clubfoot deformity is hindfoot valgus deformity of the ankle and/or the subtalar joint leading to calcaneofibular and/or anterior ankle impingement and flatfoot deformity. The purpose of this prospective study was to assess the radiographic outcome, pain relief, and functional improvement in patients with symptomatic overcorrected clubfoot deformity who were managed with a supramalleolar osteotomy.
  
  
  METHODS
  Fourteen patients with an overcorrected clubfoot deformity and a mean age of 36.9 ± 14.0 years were managed with a supramalleolar osteotomy. The mean duration of follow-up was 50.6 months. Radiographic assessment included comparison of the preoperative and postoperative distal tibial joint surface angle, tibiotalar angle, and amount of calcaneal offset on the hindfoot alignment view. Clinical outcomes were quantified with use of a visual analog score for pain and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score.
  
  
  RESULTS
  No perioperative complications occurred. Radiographically, all osteotomy sites healed within eight weeks and the orientation of the distal tibial articular surfaces was normalized in all cases. Clinically, calcaneofibular and anterior ankle impingement resolved in all patients and the mean visual analog score for pain decreased significantly from 4.1 ± 1.7 to 2.2 ± 1.5 (p < 0.05). The mean AOFAS hindfoot score increased significantly from 51.6 ± 12.3 preoperatively to 77.8 ± 11.8 postoperatively (p < 0.05). The ankle motion increased significantly from 25° ± 12° preoperatively to 29° ± 9° postoperatively (p < 0.05). All patients walked in normal shoes.
  
  
  CONCLUSIONS
  Supramalleolar osteotomy is an effective surgical procedure for the treatment of ankle impingement in patients with an overcorrected congenital clubfoot deformity. The correction is associated with a low risk of perioperative complications and leads to significant reduction of pain, increased ankle motion, and improved clinical outcome (p < 0.05).
authors.affiliation: Department of Orthopaedic Surgery, Kantonsspital Liestal, Liestal, Switzerland. markus.knupp@ksli.ch
authors.forename: Markus
authors.initials: M
authors.lastname: Knupp
authors.forename: Alexej
authors.initials: A
authors.lastname: Barg
authors.forename: Lilianna
authors.initials: L
authors.lastname: Bolliger
authors.forename: Beat
authors.initials: B
authors.lastname: Hintermann
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000002:abnormalities* / Q000601:surgery*; D003025:Clubfoot / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D016896:Treatment Outcome