title: Long-term Results After Extensive Soft Tissue Release in Very Severe Congenital Clubfeet.
abstract: BACKGROUND
  The purpose of this study was to determine the long-term results, at an average follow-up of 22 years, in 66 patients (105 clubfeet) with very severe congenital idiopathic clubfeet according to the Dimeglio-Bensahel scale.
  
  
  METHODS
  Patients were treated with an extensive soft tissue release in infancy. Results of the treatment were assessed according to the 100-point system of Ghanem-Seringe. At the latest follow-up, all participants were evaluated with regard to pain and the overall function of the lower extremities. At the latest follow-up, anteroposterior and lateral radiographs of the affected foot and the contralateral normal foot, when applicable, were performed.
  
  
  RESULTS
  In total, 92% of the patients were satisfied. The mean functional score of Ghanem-Seringe was 70.4 points. No foot had an excellent result, 19 feet had a good result, 16 had a fair result, and 70 had a poor result. A total of 86 feet were painful after strenuous activities or during walking. Eleven patients walked with a limp. In total, 82 feet were stiff. Ankle dorsiflexion and plantar flexion averaged 4.0±4.5 degrees and 19.9±10.7 degrees. Bone deformations such as flattening of the talar dome were observed in 93 feet. Among these feet, the Ghanem score was significantly lower (P<0.05). Necrosis of the navicular was present in 28 feet and subluxation in 82 feet. In total, 32 feet had moderate osteoarthritis.
  
  
  CONCLUSIONS
  Results revealed that despite anatomically and radiologically imperfect clubfeet, most patients demonstrated satisfaction. Satisfaction was not significantly correlated with residual deformity, but with the sensation of a normal gait by the patient and the high initial Dimeglio-Bensahel score. Female patients were significantly less satisfied than male patients because they were more constrained in their social life than boys. Their main dissatisfaction was the atrophy of the calf. We noted several residual deformations. Plantar release seems to contribute to the high rate of overcorrection in our series. Extensive posterolateral and plantar releases in very severe clubfeet was responsible for sequelae, morphologic, anatomic, and functional, especially in adulthood. Deterioration of results over time was confirmed by our series.
  
  
  METHODS
  Level IV.
authors.affiliation: *Orthopaedic Pediatric Surgery Department, Lapeyronie University Hospital, Montpellier †Saint-Pierre Pediatric Rehabilitation Center, Palavas les Flots, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Alkar
authors.forename: Djamel
authors.initials: D
authors.lastname: Louahem
authors.forename: Frédérique
authors.initials: F
authors.lastname: Bonnet
authors.forename: Karine
authors.initials: K
authors.lastname: Patte
authors.forename: Marion
authors.initials: M
authors.lastname: Delpont
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cottalorda
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D003025:Clubfoot / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000503:physiopathology; D005684:Gait; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome