Single-stage correction for clubfoot associated with myelomeningocele in older children: early results

Background: Clubfoot deformity associated with myelomeningocele usually is difficult to treat because of rigidity and other associated factors. The treatment becomes even more difficult when the child presents late for the treatment. Limited resources and high recurrence rates with conventional procedures led to evolution of new single-staged, surgical procedures consisting of percutaneous Achilles tenotomy, plantar fasciotomy, and closing dorsolateral wedge osteotomy. The aim of the study was to evaluate the outcome of this single-stage procedure. Methods: Fifty-eight children with clubfoot deformity associated with myelomeningocele were operated on using the described procedure in this longitudinal follow-up study. Only those children with minimum 4 years follow-up were included. Thirty-four children (42 feet) were available for preoperative, intraoperative, and postoperative follow-up evaluations. Detailed morphological, functional, and radiographic scoring was done as per International Clubfoot Study Group. Mean age of the children at the time of the described surgical procedure was 8 +/- 2.5 (range 4-12) years. The mean follow-up period was 59.3 +/- 10.4 (range 48-84) months. Results: At final follow-up, out of 42 feet, four feet (9.52%) had excellent, 30 feet (71.42%) had good, five feet (11.90%) had fair, and thee feet (7.14%) had poor results. All 16 feet with preoperative ulcers at the pressure area and eight feet with preoperative osteomyelitis of underlying bones showed good healing in the postoperative period. Conclusions: Percutaneous Achilles tenotomy with plantar fasciotomy and closing dorsolateral wedge osteotomy is a good procedure for management of clubfoot associated with myelomeningocele.