Relapse in surgically treated clubfoot: treatment approach and midterm results of revision surgery
Keywords:
Relapse clubfoot, surgical treatmentAbstract
Background and aim:
The rate of recurrence of surgically early treated clubfoot is around 25% and the treatment of clubfoot recurrence remains debated. The aim of the study is to report a case series of 15 patients (16 feet) surgically treated for relapse of surgically treated clubfoot. Methods: A careful clinical and radiological evaluation of each deformity was made. The treatment algorithm was based on the pathological anatomy of the relapse, on the patient's age and on the use of a combination of surgical steps involving bones, soft tissue or both. Results: The average age of patients at the time of relapse treatment was 8 years and 6 months, with an average follow-up of 2 years. The average Avatar score was 77 (good result). The 16 feet submitted to evaluation obtained the following scores: 6 excellent, 4 good, 4 mediocre and 2 poor. Conclusions: The number of previous interventions does not seem to be related to the outcome. The clinical and radiological evaluation of the deformity is the most important step for the right application of the algorithm. The use of a treatment approach based on age and on the systematic treatment of bony and soft tissues leads to reproducible clinical results with functional improvement.
References
Werler MM , Yazdy MM , Mitchell AA , Meyer RE , Druschel CM , Anderka M , Kasser JR , and Mahan ST , Descriptive epidemiology of idiopathic clubfoot. American Journal of Medical Genetics, Part A 2013. 161: 1569–1578.
Pryor GA , Villar RN , Ronen A , and Scott PM , Seasonal variation in the incidence of congenital talipes equinovarus. The Journal of bone and joint surgery. British volume 1991. 73: 632–4.
Zhao D , Liu J , Zhao L , and Wu Z , Relapse of clubfoot after treatment with the ponseti method and the function of the foot abduction orthosis. CiOS Clinics in Orthopedic Surgery 2014. 6: 245–252.
Ponseti, I. V and Smoley, E.N. Congenital club foot: The results of treatment. The Journal of Bone and joint Surgery. , 45(2) . (1963).
Cooper DM , and Dietz FR , Treatment of idiopathic clubfoot: A thirty-year follow-up note. Journal of Bone and Joint Surgery - Series A 1995. 77: 1477–1489.
Pous JG , and Dimeglio A , Neonatal surgery in clubfoot. The Orthopedic clinics of North America 1978. 9: 233–40.
Turco VJ , Surgical correction of the resistant club foot. One-stage posteromedial release with internal fixation: a preliminary report. The Journal of bone and joint surgery. American volume 1971. 53: 477–97.
Radler, C. and Mindler, G.T. Treatment of Severe Recurrent Clubfoot. Foot and Ankle Clinics. , 20(4) , 563–586. (2015).
Klaue, K. and Filipe, G. Long-Term Review of Juvenile Clubfoot Correction by Posteromedial Release: Clinical and Radiological Results. In The Clubfoot; Springer New York, 1994; pp. 223–229.
Ippolito E , Farsetti P , Caterini R , and Tudisco C , Long-term comparative results in patients with congenital clubfoot treated with two different protocols. Journal of Bone and Joint Surgery - Series A 2003. 85: 1286–1294.
Atar D , Lehman WB , Grant AD , and Strongwater AM , Revision surgery in clubfeet. Clinical orthopaedics and related research 1992. 223–30.
Eidelman, M., Kotlarsky, P., and Herzenberg, J.E. Treatment of relapsed, residual and neglected clubfoot: Adjunctive surgery. Journal of Children’s Orthopaedics. , 13(3) , 293–303. (2019).
Vizkelety T , and Szepesi K , Reoperation in treatment of clubfoot. Journal of pediatric orthopedics 1989. 9: 144–7.
Sambandam SN , and Gul A , Stress radiography in the assessment of residual deformity in clubfoot following postero-medial soft tissue release. International Orthopaedics 2006. 30: 210–214.
Tarraf YN , and Carroll NC , Analysis of the components of residual deformity in clubfeet presenting for reoperation. Journal of Pediatric Orthopaedics 1992. 12: 207–216.
Lehman WB , Atar D , Grant AD , and Strongwater AM , Treatment of failed clubfoot surgery. Journal of Pediatric Orthopaedics Part B 1994. 3: 168–170.
Ettl V , Kirschner S , Krauspe R , and Raab P , Midterm results following revision surgery in clubfeet. International Orthopaedics 2009. 33: 515–520.
Shalaby H , and Hefny H , Correction of complex foot deformities using the V-osteotomy and the Ilizarov technique. Strategies in trauma and limb reconstruction (Online) 2007. 2: 21–30.
Coleman SS , and Chesnut WJ , A simple test for hindfoot flexibility in the cavovarus foot. Clinical orthopaedics and related research 1977. 60–2.
Andreasi A , [Surgical treatment of anterior pes cavus in adults]. La Chirurgia degli organi di movimento 1981. 67: 445–54.
Alazzawi, S., Sukeik, M., King, D., and Vemulapalli, K. Foot and ankle history and clinical examination: A guide to everyday practice. World Journal of Orthopaedics. , 8(1) , 21–29. (2017).
Ezra E , Hayek S , Gilai AN , Khermosh O , and Wientroub S , Tibialis anterior tendon transfer for residual dynamic supination deformity in treated club feet. Journal of Pediatric Orthopaedics Part B 2000. 9: 207–211.
Stuberg W , Temme J , Kaplan P , Clarke A , and Fuchs R , Measurement of tibial torsion and thigh-foot angle using goniometry and computed tomography. Clinical Orthopaedics and Related Research 1991. 208–212.
Gourdine-Shaw, M.C., Lamm, B.M., Herzenberg, J.E., and Bhave, A. Equinus Deformity in the Pediatric Patient: Causes, Evaluation, and Management. Clinics in Podiatric Medicine and Surgery. , 27(1) , 25–42. (2010).
Pohl M , and Nicol RO , Transcuneiform and opening wedge medial cuneiform osteotomy with closing wedge cuboid osteotomy in relapsed clubfoot. Journal of pediatric orthopedics 2003. 23: 70–3.
Simons GW , Analytical radiography of club feet. Journal of Bone and Joint Surgery - Series B 1977. 59 B: 485–489.
Vanderwilde R , Staheli LT , Chew DE , and Malagon V , Measurements on radiographs of the foot in normal infants and children. Journal of Bone and Joint Surgery - Series A 1988. 70: 407–415.
McHale KA , and Lenhart MK , Treatment of residual clubfoot deformity--the “bean-shaped” foot--by opening wedge medial cuneiform osteotomy and closing wedge cuboid osteotomy. Clinical review and cadaver correlations. Journal of pediatric orthopedics 1991. 11: 374–81.
Katz, M.A., Davidson, R.S., H Chan, P.S., Sullivan, R.J., and diagnosis, Mda. Plain Radiographic Evaluation of the Pediatric Foot and Its Deformities. 10. (1997).
Thompson, G. H., Hoyen, H. A., and Barthel, T. In Tibialis anterior tendon transfer after clubfoot surgery, Springer New York: 2009.
Ippolito E , Ricciardi-Pollini PT , Tudisco C , and Ronconi P , The treatment of relapsing clubfoot by tibialis anterior transfer underneath the extensor retinaculum. Italian journal of orthopaedics and traumatology 1985. 11: 171–7.
Krause, F. G. and Guyton, G. P. Pes Cavus. In Mann’s Surgery of the Foot and Ankle; Coughlin, M. J., Mann, R. A., Saltzman, C. L., Eds.; Elsevier Saunders: Philadelphia, 2014; pp. 1361–1383.
Firth GB , McMullan M , Chin T , Ma F , Selber P , Eizenberg N , Wolfe R , and Graham HK , Lengthening of the gastrocnemius-soleus complex an anatomical and biomechanical study in human cadavers. Journal of Bone and Joint Surgery - Series A 2013. 95: 1489–1496.
Dwyer FC , Osteotomy of the calcaneum for pes cavus. The Journal of bone and joint surgery. British volume 1959. 41-B: 80–6.
Lamm BM , Gesheff MG , Salton HL , Dupuis TW , and Zeni F , Preoperative Planning and Intraoperative Technique for Accurate Realignment of the Dwyer Calcaneal Osteotomy. Journal of Foot and Ankle Surgery 2012. 51: 743–748.
Lapidus PW , Dorsal bunion: its mechanics and operative correction. The Journal of Bone & Joint Surgery 1940. 22: 627–637.
Ohly NE , and Macnicol MF , Hallux flexus: Review of current opinion on aetiology and management. Current Orthopaedics 2005. 19: 461–466.
Kuo, K. N. “Reverse Jones” Procedure for Dorsal Bunion Following Clubfoot Surgery. In The Clubfoot; Simons, G. W., Ed.; Springer: New York, 1993; pp. 384–387.
Rampal V , Chamond C , Barthes X , Glorion C , Seringe R , and Wicart P , Long-term results of treatment of congenital idiopathic clubfoot in 187 feet: Outcome of the functional “french” method, if necessary completed by soft-tissue release. Journal of Pediatric Orthopaedics 2013. 33: 48–54.
Jauregui JJ , Zamani S , Abawi HH , and Herzenberg JE , Ankle Range of Motion after Posterior Subtalar and Ankle Capsulotomy for Relapsed Equinus in Idiopathic Clubfoot. Journal of Pediatric Orthopaedics 2017. 37: 199–203.
Dunn HK , and Samuelson KM , Flat-top talus. A long-term report of twenty club feet. The Journal of bone and joint surgery. American volume 1974. 56: 57–62.
Kolb A , Willegger M , Schuh R , Kaider A , Chiari C , and Windhager R , The impact of different types of talus deformation after treatment of clubfeet. International Orthopaedics 2017. 41: 93–99.
Ceccarelli, F.; Pedrazzini, A.; Carolla, A.; and Giannini, S. Il trattamento chirurgico a “cielo aperto” degli esiti di piede torto congenito equini-varo-supinato. In Il Piede Pediatrico; Guelfi, M., Ceccarelli, F., Vittore, D., Eds.; Timeo Editore: Bologna, 2010; pp. 125–134.
Lehman WB , Atar D , Bash J , Grant A , Feldman D , Kissin Y , Gutman J , and Lindsey J , Results of complete soft tissue clubfoot release combined with calcaneocuboid fusion in the 4-year to 8-year age group following failed clubfoot release. Journal of Pediatric Orthopaedics Part B 1999. 8: 181–186.
Joseph TN , and Myerson MS , Correction of multiplanar hindfoot deformity with osteotomy, arthrodesis, and internal fixation. Instructional course lectures 2005. 54: 269–76.
Horton GA , Myerson MS , Parks BG , and Park YW , Effect of calcaneal osteotomy and lateral column lengthening on the plantar fascia: a biomechanical investigation. Foot & ankle international 1998. 19: 370–3.
Hadfield M , Snyder J , Liacouras P , Owen J , Wayne J , and Adelaar R , The effects of a medializing calcaneal osteotomy with and without superior translation on Achilles tendon elongation and plantar foot pressures. Foot and Ankle International 2005. 26: 365–370.
Joseph B , Bhatia M , and Nair NS , Talo-calcaneal relationship in clubfoot. Journal of Pediatric Orthopaedics 2001. 21: 60–64.
Tennant, J.N., Carmont, M., and Phisitkul, P. Calcaneus osteotomy. Current Reviews in Musculoskeletal Medicine. , 7(4) , 271–276. (2014).
Ricco, A. I.; Richards, B. S.; and Herring, J. A. Disorders of foot. In Tachdjian’s Pediatric Orthopaedics: From the Texas Scottish Rite Hospital for Children; Herring, J. A., Tachdjian, M. O., Eds.; Elsevier Saunders: Dallas, Texas, 2013; pp. 761–883.
Handelsman JE , and Weinberg J , Supramalleolar wedge osteotomy: A method of correcting fixed equinus and associated deformities in children. Foot 2005. 15: 33–39.
Patel A , and DiGiovanni B , Association between plantar fasciitis and isolated contracture of the gastrocnemius. Foot and Ankle International 2011. 32: 5–8.
Barske, H.L., DiGiovanni, B.F., Douglass, M., and Nawoczenski, D.A. Current concepts review: Isolated gastrocnemius contracture and gastrocnemius recession. Foot and Ankle International. , 33(10) , 915–921. (2012).
Botte, M. J. Neuromuscolar disorders. In Foot & Ankle; Thordarson, D. B., Ed.; Lippincott Williams & Wilkins: Philadelphia, 2004; pp. 41–78.
Lourenco AF , Dias LS , Zoellick DM , and Sodre H , Treatment of residual adduction deformity in clubfoot: the double osteotomy. Journal of pediatric orthopedics 2001. 21: 713–8.
Gordon JE , Luhmann SJ , Dobbs MB , Szymanski DA , Rich MM , Anderson DJ , and Schoenecker PL , Combined midfoot osteotomy for severe forefoot adductus. Journal of pediatric orthopedics 2003. 23: 74–8.
Riganti S , Coppa V , Nasto LA , Stadio M Di , Calevo MG , Gigante AP , and Boero S , Treatment of complex foot deformities with hexapod external fixator in growing children and young adult patients. Foot and Ankle Surgery 2018. 0:
Ferreira RC , Costa MT , Frizzo GG , and Santin RAL , Correction of Severe Recurrent Clubfoot Using a Simplified Setting of the Ilizarov Device. Foot & Ankle International 2007. 28: 557–568.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Mario Marinelli, Danya Falcioni, Antonio Pompilio Gigante , Valentino Coppa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
