Therapeutic effect of posterior release in the treatment of clubfoot deformity

Background: It is difficult to obtain adequate recoveries of the ankle dorsiflexion function only by Ponseti method in serious clubfoot deformity. The surgery of posterior release (PR) could be a useful option in this condition. This study evaluates the effective range of this operation, and describes the components and details of the procedure. Methods: A retrospective clinical review of 22 patients with 24 feet was performed to evaluate the surgery. The surgery was performed from January 1, 2017 to December 31, 2017. The patients' information was initially collected before surgery, including the severity of the deformity which was evaluated using a Pirani scoring system with a full score of 6 points. The number of series plaster and the degree of ankle planter flexion were recorded. After series plaster by Ponseti method, the patients underwent PR if there was severe plantar flexion deformity. Each case of PR was recorded independently in three stages, namely tendon-Achilles lengthening (TAL), tendon-flexor lengthening (TFL), posterior capsula release (PCR), PR = TAL+TFL+PCR. The median age in operation was 10 months. Results: In the operation of PR, the average correction angle was 66.96 +/- 21.92 degree. PCR was the core part in this procedure and average correction angle was 44.38 +/- 16.55 degree. The average correction angle of TAL was 19.98 +/- 14.47 degrees, and the average correction angle of TFL was 7.32 +/- 4.58 degrees. Conclusion: PR surgery is a useful supplement to the Ponseti method. The PCR and TAL are the main steps.