Title: Long-Term Follow-up of Patients with Clubfeet Treated with Extensive Soft-Tissue Release
Authors: Dobbs MB, Nunley R, Schoenecker PL
Source: Journal of Bone and Joint Surgery 2006; 88A: 986-996.
PODIATRIC RELEVANCE:
To date, there are no long-term follow up studies of patients with idiopathic clubfoot who were treated with an extensive soft tissue release. However, there are several studies showing favorable results after treatment of idiopathic clubfoot via serial manipulations and casts. Most long-term follow up studies of clubfeet treated with an extensive soft-tissue release were followed into there teens, which may be inadequate to assess foot function into adulthood. This article attempts to determine true long term results, at a minimum of twenty-five years, in a group of patients who had extensive soft-tissue releases in infancy.
METHODS:
A retrospective study of patients from St. Louis Shriners Hospital in whom idiopathic clubfoot was treated with an extensive soft-tissue release was performed. Forty-five patients (seventy-three feet) in whom idiopathic clubfoot was treated were broken down into two groups on the basis of the extent of initial clubfoot release. Group one was treated with a posterior release and plantar fasciotomy (eight patients), and group two was treated with an extensive combined subtalar, posterior, medial, and lateral release (thirty-seven patients). The mean follow-up was thirty years.
Patients were evaluated with detailed lower extremity examinations and radiographic examinations that included grading of level of osteoarthritis. Patients were also given three independent quality of life questionnaires, including the Short Form-36 Medical Outcomes Study.
RESULTS:
The two groups of patients were directly compared. No significant difference between the two groups was noted in terms of quality of life issues, the position of the heel, ankle joint range of motion, or radiographic findings. At the time of follow-up, the majority of patients in both treatment groups had a significant limitation of foot function, which was consistent with the three independent quality-of-life questionnaires. It was noted that patients who had multiple surgical procedures had significantly less range of motion of the ankle and subtalar joints than did the patients with only one surgical procedure. The ponseti method of manipulation and cast immobilization results in initial correction rates of greater than 90%, with very few patients (2.5%) needing an extensive soft-tissue release.
COMMENTS:
Many patients with clubfoot treated with an extensive soft-tissue release have poor long-term foot function. A correlation between the extent of the soft-tissue release and the degree of functional impairment was found in this retrospective study. Repeated soft tissue releases can result in an arthritic, painful, and stiff foot and ankle which can significantly impair the patients’ quality of life. Because there will always be patients with idiopathic clubfoot treated surgically, the data from this paper suggests that an operative plan that minimizes frequent or invasive surgical intervention may result in greater long-term success.
________________________________________________________________________________________
Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.