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BACKGROUND: Outcome following management of congenital talipes equinovarus (clubfoot) can be assessed in a number of ways. Bjonness stated simply that "the patient is the final judge of whether he has a good foot"; a purely subjective assessment. Others have employed objective measures. Combining subjective evaluation with a more objective assessment of movement and position of the foot, is likely to give a more comprehensive picture of the final result of clubfoot. The purpose of this study was to compare subjective and objective outcome following management of clubfoot, and evaluate sex differences in outcome.
METHODS: We used a patient-administered subjective assessment of outcome following treatment of clubfoot and compared it with objective anthropometry and range of movement of the ankle to assess and compare subjective and objective outcome in clubfoot. Statistical analysis was performed using Pearson correlation coefficients. Significance was tested using Student's t-test test.
RESULTS: Objective outcome can be assessed using length of the foot, calf circumference and range of movement at the ankle. These are easy to measure, reproducible, and correlate well with subjective outcome. Objective outcome is comparable for boys and girls. However, subjectively, female patients and their parents are less happy with the results of management of clubfoot.
CONCLUSION: There is a correlation between the anthropometric measures and the subjective outcome and an objective grading can be designed using foot length, calf muscle bulk and range of movement at the ankle.
BACKGROUND:: The dorsal bunion deformity consists of the elevation of first metatarsal head, plantar flexion contracture at the first metatarsophalangeal joint, and dorsiflexion contracture of the tarsometatarsal joint. A reverse Jones procedure with transfer of the flexor hallucis longus to the metatarsal head has been an effective method in correcting this deformity.
METHODS:: This is a retrospective review of 27 patients with 33 feet who had reverse Jones procedure with or without metatarsal osteotomy between 1983 and 2002. All patients had previous soft tissue releases for clubfoot deformity. Clinical reviews included muscle function test and radiographic evaluation before and after procedures. We used the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-interphalangeal scale for functional outcome results.
RESULTS:: The average follow-up was 4.96 years. There were 21 boys and 6 girls. Average age at time of procedure was 13.7 years. With the reverse Jones procedure, there were 18 first metatarsal osteotomies and 12 split anterior tibial tendon transfers.Before surgery, decreased muscle strength in triceps surae (73%), tibialis posterior (76%), peroneus longus (67%), and extensor hallucis longus (76%) was noted. Patients (84.9%) had normal tibialis anterior and flexor hallucis longus power.In radiographic evaluations, the operation resulted in decreased elevation of the first metatarsal by measuring the metatarsal-horizontal angle. The lateral metatarsophalangeal angle improved from 23 degrees plantar flexion to 1 degree in dorsiflexion.The average global American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-interphalangeal score was 70 preoperatively and 92 postoperatively with improvement of subscores in pain, activity, footwear, range of motion, callus, and alignment.
CONCLUSIONS:: Dorsal bunion is a recognized long-term complication after clubfoot surgery. The causes of the deformity are weakness of Achilles tendon, overpowering of flexor hallucis longus, and strong anterior tibial tendon with weakness of peroneus longus. The reverse Jones procedure improved the condition in this series and provided a long-lasting and effective correction of the dorsal bunion deformity.
The 12-in-1 Procedure for the Treatment of Congenital Idiopathic Clubfoot.
Dailiana ZH, Beris AE, Malizos KN, Varitimidis SE, Hantes M, Soucacos PN. J Surg Orthop Adv. 2008 Fall;17(3):188-92.
Quote:
The purpose of this study was to assess the long-term results of an extended soft tissue release in a single procedure, for the treatment of congenital idiopathic clubfoot. Seventeen patients with 22 congenital idiopathic clubfeet were treated surgically with the 12-in-1 procedure. The majority of cases were grade III (severe) deformities. The procedure consisted of dividing or lengthening 12 elements of the posterior, medial, and plantar side of the foot. The mean follow-up period was 11 years (range, 7-18 years). Revision surgery was required within 1 to 3.5 years of the initial procedure in four cases (residual deformity), whereas in another patient, bilateral camptodactyly was corrected 11 years postoperatively. At the time of the most recent follow-up, and after the revision procedures in patients with residual or recurrent deformities, results were excellent in 8 and good in 14 cases. The long-term follow-up results of the 12-in-1 procedure are encouraging for the treatment of idiopathic congenital clubfoot.
Clubfoot outcomes
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