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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 8/2013

01-08-2013 | Clinical Research

Can Selective Soft Tissue Release and Cuboid Osteotomy Correct Neglected Clubfoot?

Authors: Cesare Faldini, MD, Francesco Traina, MD, Alberto Di Martino, MD, PhD, Matteo Nanni, MD, Francesco Acri, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 8/2013

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Abstract

Background

Neglected clubfoot in older children is characterized by a stiff, nonreducible deformity with relative elongation of the lateral column of the foot with respect to the medial column. Surgical correction often has involved a double osteotomy with elongation of the medial column and shortening of the lateral column, or the use of an external fixator to achieve more gradual correction. Both approaches have shortcomings.

Questions/purposes

We therefore (1) used objective physical examination measurements and a functional assessment to evaluate the effectiveness of cuboid osteotomy combined with a selective soft tissue release to achieve correction of neglected clubfoot in older children, (2) determined the rate of complications, and (3) ascertained whether the initial correction achieved was maintained.

Methods

We reviewed 31 patients (56 feet) older than 5 years with severe, neglected nonreducible clubfoot deformity who underwent the index procedure. Minimum followup was 2 years (average, 6 years; range, 2–9 years). Postoperatively, the Laaveg and Ponseti classification and Dimeglio score were used to grade correction. Complication rates were tallied.

Results

According to the Laaveg and Ponseti classification, 24 feet showed excellent correction, 20 good, nine fair, and three poor at 1-year followup. These results were maintained up to the latest followup. Patients showed significant improvement of Dimeglio score after surgery (p < 0.0001). Two patients had postoperative skin-related complications that healed without additional surgery.

Conclusions

Cuboid subtraction osteotomy combined with posteromedial release is an effective approach to manage a stiff nonreducible neglected clubfoot deformity in older children.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Appendix
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Metadata
Title
Can Selective Soft Tissue Release and Cuboid Osteotomy Correct Neglected Clubfoot?
Authors
Cesare Faldini, MD
Francesco Traina, MD
Alberto Di Martino, MD, PhD
Matteo Nanni, MD
Francesco Acri, MD
Publication date
01-08-2013
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 8/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-013-2977-8

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