Abstract
Little is known about the risk of later development of osteoarthritis after operative clubfoot correction. There are only a few long-term reports of 30 years and more after operative correction with a standard technique.
Slight deformity after correction of an idiopathic clubfoot may be well tolerated by children and young adults. However, if these slight deformities become symptomatic with advancing age remains unsettled. To answer this question, a long-term follow-up of more than 30 years is needed. Functional and radiological correlation is poor in the adult foot with a slight under-corrected clubfoot deformity. A computer-assisted foot scan will provide the exact static and dynamic measurement of the pressure under each part of the foot at every moment of gait. This instrument allows better analysis of residual clubfoot.
Between 1962 and 1966 we operated 15 children with the standard operative technique of Phelps-Codivilla. In all cases there was a persistent deformity after continuous casting since birth. In two cases a heal cord lengthening procedure had been previously performed. Mean age at operation of the four girls and 11 boys was four (1 to 8) years. Six had unilateral involvement, whereas the remaining nine patients required bilateral surgery. In four cases there was a second medial release for relapse. A Steindler procedure was used in two cases and in two cases correction of clawtoes was necessary. Operative technique: Two separate incisions were made. One was longitudinal posterior that enabled lengthening of the heel cord, the tendon of the tibialis posterior and long flexors, as well as release of the posterior capsule. A second incision was made on the medial aspect of the foot in order to release the talonavicular and navicularcuneiform joints. The reduced navicular was fixed with a K-wire.
Twelve patients were examined clinically, radiologically and by functional testing after a mean follow-up of 33.5 (34 to 38) years. Eight patients had no pain and were not disturbed. There was a slight malreduction of the subtalar joint, but without any signs of joint degeneration. The foot pressure showed overpressure of the lateral forefoot. Four patients had pain and functional limitation. Their complaints had begun only two to four years earlier, and had been asymptomatic until then. All patients developed osteoarthritis of the subtalar joint, and their foot scans were abnormal.
Definitive assessment of the successful treatment of idiopathic clubfoot deformity is only possible with a long-term follow-up study. A slight undercorrection can be functionally well tolerated for a long period of time. The first occurrence of pain is still possible at the age of 35 years and older. A computer-assisted assessment of foot pressure by using a foot scan is a sensitive diagnostic tool.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
