Combined lateral and transcuneiform without medial osteotomy for residual clubfoot for children

• Main Authors: Mahadev, A., Munajat, I., Mansor, A., Hui, J.H.P.
• Format: Article
• Language: English
• Published: Lippincott, Williams & Wilkins 2009
• Subjects: R Medicine
• Online Access: http://eprints.um.edu.my/3328/1/Combined_Lateral_and_Transcuneiform_without_Medial_Osteotomy_for_Residual_Clubfoot.pdf; http://eprints.um.edu.my/3328/; http://pubmedcentralcanada.ca/articlerender.cgi?artid=1593235

Residual deformity in resistant clubfoot is not uncommon. The "bean-shaped foot" exhibits forefoot adduction and midfoot supination and may interfere with function due to poor foot placement. For children less than 5 years of age we describe a corrective procedure combining a closing wedge cuboidal osteotomy and trans-midfoot rotation procedure without a medial opening wedge osteotomy. We retrospectively reviewed twelve patients (14 feet), mean age 4.7 years (range, 4-5 years), who had undergone the procedure to correct forefoot adduction and midfoot supination deformities. We obtained minimal access via a small lateral skin incision. Cuboid lateral wedge osteotomy was followed by transcuneiform osteotomy using a Kirschner wire as a guide under an image intensifier. The minimum followup was 2 years (mean, 2.6 years; range, 2�3.2 years). All patients had qualitative improvement in correction of adduction and supination deformities. Radiographically there was an improvement in adduction deformity, the mean anteroposterior talo-first metatarsal and calcaneo-fifth metatarsal angles improved by 28° (from 40° to 12°) and by 11° (from 21° to 10°). The supination improved by 11° (from 19° to 8°) and the cavus improved by 17° (from 30° to 13°). The short-term outcome was reliable and this combination is useful for children younger than 5 years old where the medial cuneiform ossification center remained poorly defined.