title: Ankle Range of Motion After Posterior Subtalar and Ankle Capsulotomy for Relapsed Equinus in Idiopathic Clubfoot.
abstract: BACKGROUND
  Posterior capsulotomy can correct residual clubfoot deformity, but has been associated with ankle stiffness. The purpose of this study was to evaluate clinical ankle range of motion (ROM) following posterior capsulotomy immediately postsurgery and during long-term follow-up.
  
  
  METHODS
  A retrospective clinical and radiographic review of 257 patients (398 feet) was performed to evaluate all patients who required a posterior capsulotomy as part of their clubfoot management. Twenty feet (16 patients) were identified with a mean age of 73.3±37.7 months and mean Pirani score of 5.2±0.8 points. Following capsulotomy, a long-leg cast was placed and maintained for a mean of 26 days (range, 21 to 35 d). At cast removal, parents were trained and instructed to immediately begin home physiotherapy. The capsulotomy cohort was age and sex matched to a cohort treated exclusively with the Ponseti method for comparison. Children in the comparison cohort had a mean Pirani score of 5.7±0.8 points.
  
  
  RESULTS
  The mean dorsiflexion in the capsulotomy cohort significantly increased comparing the preoperative to the immediate postoperative ROM (from -6.5 to +9.7 degrees). No significant reduction in this gain was observed at latest follow-up (to +8.3 degrees). No significant difference in the plantar-flexion angle was found. Radiographically, a significant improvement in the lateral anterior tibial-calcaneal angle angles was found (P<0.05).
  
  
  CONCLUSIONS
  If utilizing our protocol for early mobilization, limited use of capsulotomy to treat relapsed clubfoot does not necessarily reduce ankle ROM. Our protocol of placing the feet in casts for a shorter duration of time and providing early physiotherapy helps maintain ankle ROM after a posterior capsulotomy.
  
  
  METHODS
  Level III-therapeutic study.
authors.affiliation: *Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore ‡Department of Orthopaedic Surgery, University of Maryland Medical System, Baltimore, MD †Department of Orthopaedic Surgery, Atieh Hospital, Tehran, Iran.
authors.forename: Julio J
authors.initials: JJ
authors.lastname: Jauregui
authors.forename: Shirin
authors.initials: S
authors.lastname: Zamani
authors.forename: Hummira H
authors.initials: HH
authors.lastname: Abawi
authors.forename: John E
authors.initials: JE
authors.lastname: Herzenberg
mesh_terms: D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D057913:Joint Capsule Release / Q000379:methods*; D008297:Male; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular / Q000502:physiology*; D012008:Recurrence; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery; D016896:Treatment Outcome