Researchers have demonstrated the efficacy of the "French" functional method for correcting congenital idiopathic clubfoot, with the majority of patients achieving a good result, often without surgery.
Overall, 98% of the 187 affected feet (129 patients) in the study had a good or very good Ghanem and Seringe score at the last follow up, at an average age of 14.7 years, report Virginie Rampal (Nice Pediatric Hospital, France) and co-workers in the Journal of Pediatric Orthopaedics.
Soft-tissue release was required in 45.5% of the feet to correct remaining deformity after the daily regime of physiotherapy and splintage. Surgery was performed on average at age 2.5 years and included posterolateral and medial release, usually alongside tibialis anterior tendon lengthening (71%). In addition, 43% of feet required calcaneus osteotomy.
A good or very good result was achieved in over 95% of operated feet, with a fair result caused by varus greater than 5° or valgus. By the end of growth, 90% of feet had normal anterointern weight-bearing foot prints, and serious pain was reported only after serious sporting activity.
Twelve feet required reoperation for recurring deformation, two for metatarsus varus, one for hypercorrection, and three for triple arthodesis at puberty. The four patients with a fair outcome required two or three additional procedures, the researchers note.
Overall, 99% of the 98 feet that did not require surgery achieved a very good classification, and there were no fair or bad outcomes. A flattened talar dome on the lateral ankle view was reported in 50.9% of feet and a dorsal flexion of less than 10° was reported in 45%, as was subtalar joint stiffness. Thirteen (12.7%) feet had equinus.
Analysis showed that outcome was not significantly predicted by the initiation of treatment before or after 1 month of age.
However, severity of foot deformation at initial examination was significantly prognostic for both the need for surgery and the final result. Nonoperated feet were significantly more likely to achieve a good or very good outcome than those requiring surgery, with repeated surgery predicting a poorer outcome, Rampal et al note.
"Following our results, we suggest that to obtain a good result the foot should be corrected completely in a single attempt," they therefore recommend.
The authors add that the "introduction of percutaneous tenotomy of the Achilles tendon
for selected feet in the functional method may improve the final results and decrease the recourse to surgery."
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