title: Can selective soft tissue release and cuboid osteotomy correct neglected clubfoot?
abstract: BACKGROUND
  Neglected clubfoot in older children is characterized by a stiff, nonreducible deformity with relative elongation of the lateral column of the foot with respect to the medial column. Surgical correction often has involved a double osteotomy with elongation of the medial column and shortening of the lateral column, or the use of an external fixator to achieve more gradual correction. Both approaches have shortcomings.
  
  
  OBJECTIVE
  We therefore (1) used objective physical examination measurements and a functional assessment to evaluate the effectiveness of cuboid osteotomy combined with a selective soft tissue release to achieve correction of neglected clubfoot in older children, (2) determined the rate of complications, and (3) ascertained whether the initial correction achieved was maintained.
  
  
  METHODS
  We reviewed 31 patients (56 feet) older than 5 years with severe, neglected nonreducible clubfoot deformity who underwent the index procedure. Minimum followup was 2 years (average, 6 years; range, 2-9 years). Postoperatively, the Laaveg and Ponseti classification and Dimeglio score were used to grade correction. Complication rates were tallied.
  
  
  RESULTS
  According to the Laaveg and Ponseti classification, 24 feet showed excellent correction, 20 good, nine fair, and three poor at 1-year followup. These results were maintained up to the latest followup. Patients showed significant improvement of Dimeglio score after surgery (p < 0.0001). Two patients had postoperative skin-related complications that healed without additional surgery.
  
  
  CONCLUSIONS
  Cuboid subtraction osteotomy combined with posteromedial release is an effective approach to manage a stiff nonreducible neglected clubfoot deformity in older children.
authors.affiliation: Department of Rizzoli-Sicilia, Orthopaedic Service, The Rizzoli Institute, Bagheria, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Faldini
authors.forename: Francesco
authors.initials: F
authors.lastname: Traina
authors.forename: Alberto
authors.initials: A
authors.lastname: Di Martino
authors.forename: Matteo
authors.initials: M
authors.lastname: Nanni
authors.forename: Francesco
authors.initials: F
authors.lastname: Acri
mesh_terms: D000367:Age Factors; D002648:Child; D003025:Clubfoot / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D010808:Physical Examination; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013639:Tarsal Bones / Q000601:surgery*; D013710:Tendons / Q000601:surgery*; D058971:Tenotomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome