Club foot: treatment in the child, outcome in adults

NewsBot · Jun 28, 2006

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Congenital club foot: treatment in childhood, outcome and problems in adulthood
Rev Chir Orthop Reparatrice Appar Mot. 2006 Apr;92(2):175-92

PURPOSE OF THE SYMPOSIUM: Treatment of idiopathic talipes varus, or congenital clubfoot, is designed to realign the foot to alleviate pain and allow plantigrade weight bearing with adequate joint motion despite the subnormal radiographic presentation. This symposium was held to review current management practices for congenital clubfoot in children and to analyze outcome in adults in order to propose the most appropriate therapeutic solutions.

MANAGEMENT OF CONGENITAL CLUBFOOT IN CHILDREN: Idiopathic talipes varus can be suspected from the fetal ultrasound. Parents should be given precise information concerning proposed treatment after birth. Deviations must be assessed in the newborn then revised regularly using objective scales during and after the end of treatment. This enables a better apprehension of the evolution in comparison with the severity of the initial deformation. Conservative treatment is proposed by many teams: a functional approach (rehabilitation and minimal use of orthetic material) or the Ponseti method (progressive correction using casts associated with percutaneous tenotomy of the calcaneal tendon) are currently preferred. If such methods are insufficient or unsuccessful, surgery may be performed as needed at about 8 to 11 months to achieve posteromedial release. Good results are obtained in 80% of patients who generally present minimal residual deformations (adduction of the forefoot, minimal calcaneal varus, residual medial rotation, limitation of dorsal flexion), which must be followed regularly through growth. The difficulty is to distinguish acceptable from non-acceptable deformation. At the end of the growth phase, severe articular sequelae are rare (stiff joint, recurrence of initial deformation, overcorrection) but difficult to correct surgically: osteotomy, tendon transfer, double arthrodesis, Ilizarov fixator. Gait analysis is essential to quantify function and obtain an objective assessment of the impact on higher joints, providing valuable guidance for surgical correction.

OUTCOME IN ADULTHOOD: There have been very few studies evaluating the long-term functional outcome after treatment during childhood. According to two studies presented at this symposium (Brussels, Lausanne), results have been generally good but with subnormal radiographs irrespective of the type of treatment or how early treatment started in childhood. Hypoplasia of the talar dome is a constant finding and is correlated with limitation of dorsal flexion of the ankle joint. A small degree undercorrection is often observed but well tolerated while overcorrection is generally less well tolerated. Functional outcome depends highly on preservation of subtalar joint motion. There have been no reports on the results of treatment of sequelae in adults. Most problems (pain, stiffness, osteoarthritis) are observed in the mid or rear foot. Indications for conservative surgery (osteotomy) of the mid or rear foot are rare compared with indications for combined arthrodesis. Talocrural decompensation is a turning point observed in the adult. Management at this point is difficult: fusion of the ankle worsens the situation by increasing the stress on the forefoot and aggravating the disability; implantation of an ankle prosthesis is technically difficult and remains to be fully developed. Treatment of the dorsal bunion of the great toe may require tendon transfer and/or fusion.

CONCLUSION: A child born with clubfoot will never have a normal foot in adulthood. Sequelae present at the end of growth will intensify during adult life; undercorrection is easier to treat in adulthood than overcorrection. The most difficult problems in adulthood are: neglected clubfoot, over correction, and degradation of the talocrural joint.
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Admin2 · Jun 28, 2006

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NewsBot · Feb 21, 2018

The Neglected Clubfoot
Cary Fletcher
Global Journal of Medical Research: H
Volume 17 Issue 1 Version 1.0 Year 2017
Orthopedic and Musculoskeletal System

Abstract- The neglected clubfoot is an uncommon condition in the developed world that has not
been clearly defined in the literature. The condition is more common in the developing nations as
a result of lower detection rates early in life for various economic and cultural reasons. In addition
to the physical, social and financial burden which often occurs, there is a psychological
component that must be addressed prior to commencing orthopaedic management. When left
untreated beyond walking age, the weight bearing on the side of the foot worsens the deformity
in addition to the worsened contractures due to increased contractile elements in the soft tissues.
Treatment traditionally started with casting utilising the Ponseti technique followed by extensive
open surgery which may entail soft tissue procedures plus or minus bony correction. Bony
procedures involving osteotomies often result in an obviously shortened foot and may be
associated with skin necrosis, psuedoarthrosis, infection and vascular damage. These
procedures are also not uncommonly associated with pain, weakness, and stiffness of the foot
and ankle postoperatively.
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NewsBot · May 10, 2020

Late Effects of Clubfoot Deformity in Adolescent and Young Adult Patients Whose Initial Treatment Was an Extensive Soft-tissue Release: Topic Review and Clinical Case Series
Johnson, Jeffrey E. MD; Fortney, Thomas A. MD; Luk, Pamela C. MD; Klein, Sandra E. MD; McCormick, Jeremy J. MD; Dobbs, Matthew B. MD; Gordon, J. Eric MD; Schoenecker, Perry L. MD
JAAOS: Global Research and Reviews: May 2020 - Volume 4 - Issue 5 - p e19.00126

Children with congenital clubfoot often have residual deformity, pain, and limited function in adolescence and young adulthood. These patients represent a heterogeneous group that often requires an individualized management strategy. This article reviews the available literature on this topic while proposing a descriptive classification system based on a review of patients at our institution who underwent surgery for problems related to previous clubfoot deformity during the period between January 1999 and January 2012. Seventy-two patients (93 feet) underwent surgical treatment for the late effects of clubfoot deformity at an average age of 13 years (range 9 to 19 years). All patients had been treated at a young age with serial casting, and most had at least one previous surgery on the affected foot or feet. Five common patterns of pathology identified were as follows: undercorrection, overcorrection, dorsal bunion, anterior ankle impingement, and lateral hindfoot impingement. Management pathways for each group of the presenting problems is described. To our knowledge, this topic review represents the largest report of adolescent and young adult patients with residual clubfoot deformity in the literature.
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