Adult surgery rescues overcorrected club foot deformity

By Lynda Williams, Senior medwireNews Reporter

Study findings support the use of supramalleolar osteotomy for patients with hindfoot valgus or subtalar joint deformity following an overcorrected clubfoot.

All 14 patients, aged an average of 36.9 years, who underwent the procedure to correct calcaneofibular and/or anterior ankle impingement and flatfoot deformity experienced a significant improvement after surgery, allowing them to wear normal shoes.

None of the patients experienced complications during surgery, and radiographs showed that all osteotomy sites had healed and distal tibial articular surface orientation had normalized within 8 weeks, report Markus Knupp and co-workers from Kantonsspital Liestal in Switzerland.

Over an average follow-up period of 50.6 months, the tibial articular surface angle improved from 96.6° to 88.4°, and the mean tibiotalar angle from 101.1° to 92.2°. The five patients with calcaneofibular impingement with anterior ankle impingement experienced a significant improvement in tibial lateral surface angle, from 92.2° to 84.4°. Findings for seven patients showed correction of the mean offset of the calcaneal tuberosity from -12.1 to -2.3 mm on hindfoot alignment.

These improvements were accompanied by a significant decrease in pain on the visual analog scale, from an average of 4.1 to 2.2 points, where 10 is the maximum pain imagined, and a significant improvement on the American Orthopaedic Foot & Ankle Society hindfoot score from 51.6 to 77.8 points.

Ankle motion increased significantly from an average of 25° to 29°, the researchers add.

Two patients experienced superficial wound healing complications that were successfully treated with antibiotics, two patients developed progressive flatfoot deformity requiring further surgery, and three patients had repairs for isolated longitudinal tears to the peroneus brevis tendon.

"A supramalleolar osteotomy can be used to treat lateral and anterior ankle impingement in adult patients presenting with an overcorrected clubfoot deformity," the team concludes.

"However, to achieve good outcomes, a concomitant flatfoot deformity frequently needs to be addressed simultaneously."

The researchers conclude that "the findings of the present study emphasize that arthrodesis, which may lead to a high rate of adjacent-joint arthritis in these patients can be avoided in the treatment of this painful deformity."

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