Resistant Congenital Culbfoot

Hahn, Soo Bong; Jahng, Jun Seop; Kim, Nam Hyun; Chung, In Hee

Abstract

The most important congenital abnormality of the foot is clubfoot or talipes equinovarus, a deformity easy to diagnose but difficult to correct completely, even in the hands of an experienced orthopaedic surgeon. Furthermore approximately 50% of congenital clubfoot are resistant to non-operative methods such as manipulation and cast correction and consequently, under these circumstances, continuation of non-operative treatment leads to eventual failure, due either to incomplete correction, or recurrence of the deformity. In such resistant clubfoot it is better judgement to perform a relatively minor soft tissue operation at the time for resistance rather than to delay surgical treatment and beforced to perform a major operation at a late date for recurrence. Eighteen patients who presented twenty-five resistant congenital clubfoot abnormalities were followed at our department for 9 years and 4 months from February of 1970 to May of 1979. These were subjected to analysis clinically and radiologically, and the following results were obtained. 1. These patients consisted of: 11 male patients, 7 female patients, 11 single clubfeet and 7 bilateral clubfeet. 2. Age categories at operation were as follows: 6 feet below 1 year old, 8 feet 1 year old, 5 feet 2 years old, 3 feet 3 years old and one each age 4, 5 and 6. 3. Treatment period before operation: 19 clubfeet for 3 months to 6 months, 6 clubfeet for 7 months to 1 year. 4. Operations performed: posterior release-four, medial and posterior release-twelve, medial-plantar and posterior release-three, one stage posteromedial release-four, Evans procedure-one and tibialis anterior to lateral cuneiform-one. 5. Operations performed at an early age showed better results than those performed on older patients. 6. Of all operations performed the one stage posteromedial release with internal fixation showed the best results.