CONGENITAL CLUB FOOT – LONG TERM RESULTS OF MODIFIED TURCO’S PROCEDURE.

Abstract

This study was undertaken to assess the long term results of treatment of club foot by modified Turco’s Procedure.

Thirty patients with 50 feet were treated by serial casting and postero-medial release for club feet, by modified Turco’s procedure. All patients treated from January 1980 to January 1983 were included in the study. Eighteen patients with 33 club feet were available for the final follow-up. They were followed up for an average of 13.8 years, range of 10 – 16 years. There were two females while the remaining 16 males. Only three patients had unilateral affection and all were males. Only patients with idiopathic club feet were chosen for this study. All patients underwent serial plaster correction after birth till undergoing surgical correction. All procedures were carried by the senior surgeon, using the same technique. All patients were operated between the ages of 6 – 9 months, depending on the severity of deformity and correction achieved with serial plaster. A modified Turco’s technique was used. A longer incision extending to the lateral border of tendoachilles was used. The abductor hallucis was completely excised. All patients had a subtalar release as well. No K wire was used for holding the correction. All children were left in plaster till they started walking. No Dennis-Browne Splint was used, but a modified splint and correction shoes were used in the postoperative period. There were no wound problems in any cases, either at the time of wound closure or later on. They were followed with clinical and radiological examinations. There were no wound problems which is a frequent problem in most series. Three (9%) cases each had recurrence of heel varus and forefoot adduction. The forefoot adduction was less than as compared to other studies. Three cases had some cavus deformity while four cases had flat foot. All patients were noted to have calf muscle wasting. The results were assessed using Ponseti’s score. The average Ponseti’s score was 87.2 (range 49 – 98). Two feet out of 33 had recurrence of all the deformities. There were 27 good to excellent results. The most common problem was terminal restriction of dorsiflexion, but most of the patients were happy with the results. We believe that our treatment is safe, simple, giving satisfactory results in more than 80% and with minimal complications. The results are maintained over a long follow up period. We think that this modified approach helped reduce one of the common deformities to recur.