126. SURGICAL TREATMENT OF INSUFFICIENCIES OF FUNCTIONAL TREATMENT FOR IDIOPATHIC EQUINOVARUS CLUB FOOT: RESULTS AT THE END OF GROWTH

Abstract

Purpose of the study: The purpose of this work was to study outcome at the end of grow after surgical treatment for idiopathic congenital equinovarus club foot.

Material and methods: From 1983 to 1991, 63 children (85 club feet) given functional treatment underwent surgery because of insufficient results. At birth, the Dimeglio classification was II:11.7%; III:40%; IV:25.8%. Surgery was performed before the age of 2 years for 52 fee (61%) and after 2 years for 33. The indication for surgery was a triple deformity: equin (8.1±15.2, varus (8.2±13.1, adductus (32.5±13.8). Surgery was associated as needed with posterolateral release (94.1%), anteromedial release (92.9%), plantar release (61.1%) and Lichtblau shortening of the lateral column (42%). The tendon of the tibialis anterior was lengthened for 86% of the feet. Functional, clinical, and radiographic outcomes were noted at last follow-up.

Results: Mean follow-up was 15 years (8–22). Fifteen feet (17.6%) had a second operation: 13 for recurrence (repeat release), one for over correction (lengthening of the calcaneum) and one for metatarsus adductus (metatarsal osteotomies). One foot had a third operation for recurrence (repeat release). Three feet (3.5%) did not have surgery; a double arthrodesis followed progressive aggravation during growth. In the first group (surgery before 2 years), outcome was very good, good or fair for 76.9, 17.3 and 5.8% of the feet. The “fair” outcomes concerned three children who had more than one operation. In the second group (surgery after 2 years), the outcomes were 78.8%, 18.2% and 3% (n=1) respectively. The “fair” result concerned the double arthrodesis. There was no significant difference for the final outcome as a regards age at surgery (p=0.07). Among the four feet with a “fair” outcome, two were initially Dimeglio III and two Dimeglio IV.

Discussion: Soft tissue release enables correct results at the end of growth for the majority of these club feet. While the Dimeglio score is an element predictive of an indication for surgery, it is not a prognostic element for the final outcome. Age at surgery does not have a significant impact on the final outcome.