Abstract
The authors provide an analysis of the results of surgery for clubfoot at the Vilnius University Children’s Hospital in Lithuania from 1979 to 1999.
We operated 565 clubfeet in 464 patients. Average age of the patients was 4.1 years. From 1979 to 1993, 172 feet were operated. Most patients had the so-called Zacepin procedure for clubfoot release that contains a multi-stage release of different clubfoot components, but without attention to bony alignment restoration. At that time most patients were operated from 1.5 to 4 years of age. In that group 45% of the patients had a recurrence of the deformity and an additional operation was necessary.
From 1993 to 1999, 393 clubfeet were operated. Mean age of the patients was 2.7 years (range 6 months to 7.4 years.). A more extensive release was introduced using the Cincinnati approach and restoration of normal talocalcaneal and talonavicular alignment following adequate soft tissue release. In this group 14% of the patients had a recurrence.
The main goal of the clubfoot surgery was an exact reposition and fixation of the talocalcaneal and talonavicular alignment with adequate soft tissue release. The Cincinnati approach was the most effective and safe for correcting all of the components of the deformity. The best results were found in the patients who were operated at the age of six to eight months. In order to get a better functional outcome, at three to four years of age a number of our operated patients required an additional procedure such as a split tibialis anterior tendon transfer, a lateral column shortening, or a medial column lengthening. An excessive reposition of the talus produces a strange and severe foot deformity that is difficult to manage.
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.
