Abstract
Clubfoot (CF) is a congenital deformity of the foot with a multi-factorial etiology. The question of the best therapy is still open. The aim of our study was to compare the formerly used limited posteromedial release (PMR) with the recent extensive complete subtalar release (CSR).
From 1989 to 1997, 473 children were treated surgically. Our cohort contained 101 patients (129 affected feet) with CF confirmed by radiographs and physical findings. Forty-eight patients (59 feet) were operated with PMR, and 53 (70 feet) with the method of CSR after McKay. Both groups were comparable to Dimeglio’s classification concerning this type of deformity. All feet were operated on primarily with either no preceding therapy or with some conservative therapy. Average age at the time of surgery was 9.3 months.
The radiographic parameters (Kite’s angle, lateral TC angle, TC index, T-I.MTT angle, lateral tibiotalar angle) were evaluated according to Simons. The physical parameters (heel position, forefoot adduction, range of motion in the tibiotalar joint, range of motion in the subtalar joint, the process of taking off, the general shape of the foot, assessment of wearing shoes, and plantogram) were also evaluated. Assessment of the radiographs and the physical parameters showed substantially better results in the group with complete subtalar release.
A three-grade evaluation was used for assessment of the combined physical and radiographic assessment: good, fair, and poor. In the group with PMR, 54% were classified as good, 31% as fair and 15% as poor. In the CSR group, good results were achieved in 72%, fair in 17%, and poor in 11%.
The lower occurrence of re-operation in the group with subtalar release was apparent. With suitable timing, excellent results can be achieved with this operation. We conclude that extensive complete subtalar release is one of the best methods to correct this type of clubfoot. Subtalar release as described by McKay produces significantly better long-term statistical results than posteromedial release, in both clinical evaluation and radiograph assessment.
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.
