Postermomedial surgical approach with or without selective medial release of the subtalar joint in clubfoot surgery

ABSTRACT

Congenital clubfoot is a variable three dimensional complex system of chondroosseous and joints deformity. Its treatment possess a controversial issue since dates of Hippocrates. In clubfoot surgery many complications as stiffness, overcorrection, talar avascular necrosis and subsequently poor functional results were postulated by many as a sequlae to simultaneous complete subtalar release . This is a prospective study of 33 patients with 40 idiopathic clubfeet. There were 28 males [84.8%] and 5 were female [15.2%] patients.The affected sides were [left =11; right= 15; bilateral = 14 feet]. The feet were divided randomly into 2 equal groups [A and B][20 feet each]. The initial deformity was very severe in 32 feet and severe in 8 by using the Simon scale and allocated equally in both groups. All the feet were treated at a mean age of 8 months by means of posteromedial surgical soft tissue release. In addition selective medial capsular release of the subtalar joint with release of talocalcaneal interosseous ligament was done in group [A] feet where it was left intact in group [B]. At a mean follow-up period of 26 months range [24-30], the total satisfactory results were [85%]. In both groups the result was [90%] satisfactory in group [A] and [85%] in group [B] feet . When their mean overall clinical and radiological scores were investigated and comparing their satisfactory results together, group [A] feet showed statistically significant improvement of clinical and radiological parameters than those of group [B]. This was reflected clinically on better hindfoot alignment with the release of the TCIL in group [A] feet. Neither any evidence of overcorrection nor talar avascular necrosis was detected either clinically or radiologically by conventional x-ray as well as by MRI of all the studied feet in both groups. Posteromedial surgical approach with release of TCIL proved to be a good contribution in the treatment of severe and relapsing clubfeet, which gave significantly better hindfoot alignment without aforementioned serious complication