Dispelling the misconceptions of talocalcaneal interosseous ligament release in clubfoot surgery

ABSTRACT

Despite decades of experience in the topics of clubfoot considerable 1 uncertainty remains, regarding its treatment and long term results. Surgical release of talocalcaneal interosseous ligament [TCIL] possesses a controversial issue, as many thought that it has early and remote drawbacks effect as avascular necrosis of the talus and hindfoot overcorrection. This is a retrospective study of 60 idiopathic clubfeet in 43 patients were treated by posteromedial surgical approach since 14 years ago. There were 38 male patients [88.4%] and 5 were females [11.6%] . The affected side was [left =11; right= 15; bilateral = 34 feet]. The preoperative deformity was very severe in 36 feet [60%] and severe in 24 [40%] by using the Simon scale . Preoperatively the feet were divided randomly into 2 equal groups [A] and [B][30 feet each]. All the feet were treated by means of soft tissue release via posteromedial approach at mean age 9 months range [3-24 months]. In group [A] feet, the talocalcaneal interosseous ligament [TCIL] was released, where in group [B] the ligament was left intact. At mean follow-up period of 12.5 years range [11-14 years] the late follow result was satisfactory in [96.6%] in group A and [90%] in group B feet. This shows increasing of their late satisfactory percentage than their early follow up assessment. When the late total mean of both clinical and radiological scores were investigated, group [A] still graded excellent results while group [B] graded as good. The group [A] feet showed more satisfactory and statistically significant improvement of the talocalcaneal index, anteroposterior, lateral talocalcaneal and lateral calcaneus-first metatarsal angles when compared with group B elements. This was reflected clinically as it shows more better hindfoot correction with the surgical release of the TCIL .This without any evidence of significant clinical overcorrection. Magnetic resonance imaging[MRI] was performed early five months after surgery to assess talar avascular necrosis and talo-calcanio-navicular alignment .ThiV