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Pediatrics Education and Research

Volume  4, Issue 1, January - April 2016, Pages 31-37
 

Original Article

Treatment of Neglected and Relapsed Clubfoot with Midfoot Osteotomy: A Retrospective Study

P.D. Daule*, Sunil Mhaske**, Liza Bulsara***

*Associate Professor, Dept. of Orthopedics, **Professor, ***Post-Graduate, Department of Pediatrics, PDVVPF’s Medical College, Ahmednagar

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DOI: DOI: https://dx.doi.org/10.21088/per.2321.1644.4116.5

Abstract

 Background : Neglected and residual clubfoot deformities in older children is a difficult surgical problem as the foot in these patients is stiff with some amount of pain and almost always had already undergone some surgical intervention. Basic aim of foot surgeries in such cases is to achieve painless functional plantigrade foot. In this study, a percutaneous dorsolateral closing wedge midfoot osteotomy with correction of angulation and translation deformity was done fixed with k-wires or ilizarov frame. Additional procedures like plantar fascia release and Achilles lengthening procedures were done for associated deformities as required. The aim of this study is to evaluate outcome of the proposed surgical procedure in correction of complex clubfoot deformities. Methods: Our centre is a tertiary care orthopaedic hospital. A total of 25 patients [32 feet] were included in this retrospective study done from august 2009 to august 2014. Patient aged 5-12 years were selected for the surgical procedure. All the patients were followed up at least up to 18 months after surgery. Both preoperative and postoperative evaluation of patients done clinically, with help of dimeglio score, and radiologically. Results: Follow up period ranged from 18-30 months. Clinical and radiographic improvement was achieved in all the patients. Dimeglio score improved from 10.63 to 2.93 which denotes good result. All radiographic angles showed correction to near normal values. All the patient showed pain relief and optimal function at 18 month follow-up. Complications in form of pin tract infection, under correction and skin problems were noted in three, three and five patients respectively. Conclusion: A percutaneous dorsolateral closing wedge osteotomy in combination with plantar fascia release and Achilles tenotomy is a good alternative procedure for neglected and recurrent clubfoot deformities with minimal complications. This is a joint sparing surgical technique which preserves ankle and foot flexibility.

Keywords: Relapsed; Neglected; Clubfoot; Midfoot Osteotomy; Dimeglio Score.

Corresponding Author : Liza Bulsara***