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Abstract
Background: Idiopathic clubfoot is commonly treated with the Ponseti method with the extent of invasive treatment involving tendon-Achilles lengthening. Forefoot adduction is a common complication in surgically treated clubfeet. Yet, no method has been described to measure dynamic (walking) forefoot adduction. The aim of this study was to assess the persistent pes adductus in children whose clubfeet were surgically treated using a dorsomedial soft tissue release and to find out correlations between forefoot adduction and clinical outcome measures.
Methods: We analysed the dynamic adduction angle in 33 clubfeet using a pressure-sensitive foot platform and compared it to the healthy feet of an age- and weight-matched group of children without congenital foot deformities. The clinical outcome was analysed using the McKay score.
Results: Mean dynamic adduction angle was 4.1o in the surgically corrected clubfeet, whereas it was 6.4° in unaffected feet of patients with unilateral clubfoot and 7.1o in control group. The McKay score were excellent in 1 patient, good in 5, average in 13, and fair in 4 of the 23 patients. There was no correlation between dynamic adduction angle and McKay score using paired t test (P > 0.05).
Conclusion: High occurrence of dynamic adduction angle in surgically treated clubfeet was detected. In conclusion, no correlation between forefoot adduction, dynamic forefoot adduction angle and clinical outcome measures within the study was observed.
Keywords: clubfoot, congenital talipes equinovarus, equinovarus, talipes equinovarus
Introduction
Idiopathic congenital talipes equinovarus (CTEV), also known as congenital idiopathic clubfoot, is a pediatric foot deformity involving four major components: ankle equinus, hindfoot varus, forefoot in adduction, and midfoot cavus (1). Multiple treatment regimens have been used to treat clubfoot including splinting, plaster casting, surgical procedures involving medial, posterior, and lateral releases, osteotomies, and arthrodesis (2-4). Success in curing clubfoot was variable (1,5-7) until Ponseti (1) reviewed more than 50 years of data indicating that initial non-operative treatment of clubfoot is desirable regardless of the severity of the deformity (8-11).
Current treatment procedures favor the Ponseti method with the extent of "surgery" being tendon-Achilles lengthening before application of the final cast. For resistant clubfeet or failed Ponseti, the la carte surgical approach is preferred to the full posteromedial release method employed previously (1). Although treatment options vary based on the...