Correction of neglected or relapsed clubfoot deformity in an older child by single-stage procedure: early results

Background Treatment of neglected or relapsed clubfeet in older children is a challenging task. Particularly in developing countries, limited resources and difficulties in getting frequent follow-ups make selection of appropriate surgical procedures more difficult. These difficulties led to the evolution of a new single-stage surgical-procedure consisting of percutaneous Achilles tenotomy, plantar fasciotomy, and closing wedge osteotomy. The aim of the study was to evaluate the outcome of this single-staged procedure. Methods Eighty-six children, with neglected or relapsed clubfeet, were operated on using the described procedure in this longitudinal follow-up study. Only children (n = 62) who had a minimum postoperative follow-up of 3 years were included. Eight children (12.9%) were lost to follow-up. Fifty-four children (77 feet) were available for preoperative, intraoperative, and postoperative follow-up evaluations. Detailed morphological, functional and radiographic scoring was done as per the International Clubfoot Study Group. Results The age at surgery varied from 5-13 years (mean 8.35 +/- 2.64 years). Follow-up ranged from 36-62 months (mean 44.07 +/- 8.22 months). Of 77 feet, results were excellent in 41 (53.25%) feet, good in 28 (36.36%), fair in six (7.8%) and poor in two (2.6%) feet. The proportion of excellent and good results was significantly higher in neglected feet as compared with relapsed feet (P = 0.007). However, the procedure was found to be effective and useful in relapsed feet as well as neglected feet. Conclusions Percutaneous Achilles tenotomy with plantar fasciotomy and dorsal closing wedge osteotomy is a good alternative to conventional procedures for management of neglected or relapsed clubfeet. It may suit the needs of developing countries, particularly in settings where patients who come from remote villages have very poor compliance. Keywords