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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 11, 1526-1530.
doi: 10.1302/0301-620X.91B11.22327  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Selective soft-tissue release for recurrent or residual deformity after conservative treatment of idiopathic clubfoot

S.-S. Park, MD, PhD, Associate Professor1; S. W. Kim, MD, Assistant Professor2; B.-S. Jung, MD, Orthopaedic Resident1; H. S. Lee, MD, PhD, Associate Professor1; and J. S. Kim, MD, PhD, Assistant Professor1

1 Department of Orthopaedic Surgery Asan Medical Center, University of Ulsan College of Medicine, 86, Asanbyeongwongil, Songpa-gu, Seoul 138-736, Korea.
2 Department of Orthopaedic Surgery Ulsan University Hospital, 290-3, Jeonha-dong Dong-gu, Ulsan 682-714, Korea.

Correspondence should be sent to Professor S.-S. Park; e-mail: sspark{at}amc.seoul.kr

We reviewed the results of a selective à la carte soft-tissue release operation for recurrent or residual deformity after initial conservative treatment for idiopathic clubfoot by the Ponseti method. Recurrent or residual deformity occurred in 13 (19 feet) of 33 patients (48 feet; 40%). The mean age at surgery was 2.3 years (1.3 to 4) and the mean follow-up was 3.6 years (2 to 5.3). The mean Pirani score had improved from 2.8 to 1.1 points, and the clinical and radiological results were satisfactory in all patients. However, six of the 13 patients (9 of 19 feet) had required further surgery in the form of tibial derotation osteotomy, split anterior tibialis tendon transfer, split posterior tibialis transfer or a combination of these for recurrent deformity.

We concluded that selective soft-tissue release can provide satisfactory early results after failure of initial treatment of clubfoot by the Ponseti method, but long-term follow-up to skeletal maturity will be necessary.




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How we treat the residual deformity after conservative treatment of idiopathic clubfoot
Zoran S Vukasinovic, et al.
J Bone Joint Surg Br Online, 18 Nov 2009 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General