Result of the surgical tratment of Congenital Club Foot before and after two years of age

Abstract

Objective: Compare the results of the surgical treatment of congenital clubfoot deformity, using the peritalar release technique through a Cincinnati approach, before and after two years of age. Methods: Sixty-one patients (97 feet) with idiopathic congenital clubfoot deformity (CCF) were surgically treated using the same technique; 46 were males (75%) and 15 were females (25%). Thirty-six patients (59%) presented bilateral deformity. The average age at the time of surgery was 19 months, ranging from six to 66 months. Patients were subdivided into two groups: Group I (77 feet), that underwent corrective surgery before 24 months of age, and Group II (20 feet), that had the deformity corrected after 24 months of age. Functional results were assessed using the modified Lehman score. Additional variables, such as the presence of residual deformities, the degree of joint mobility of the mid and hind foot, and the gait were also evaluated. Pre and post-operative radiographs of the foot were used to study the variations in the talocalcaneous and talometatarsal angles. The mean follow-up time was 58 months (ranging from 12 to 36 months). Results: Functional results were found to be excellent in 46 feet (47%), good in 43 feet (44%), fair in two feet (2%) and poor in six feet (7%). When functional results were analyzed based on the age at surgery, it was found that 72 feet (92%) presented excellent and good results and that five feet (8%) had fair or bad results in Group I; in Group II, 17 feet (85%) presented excellent or good results and three feet (15%) had fair or poor results. The difference between the two groups was not statistically significant. However, patients who underwent surgical correction after the age of 24 months presented a greater limitation in the range of motion of the ankle, a greater incidence of residual deformity in suppination, and a greater incidence of over-correction (rocking-boat foot). On lateral radiographic images of the foot, this group also showed an overall reduced capacity of correction of the alignment between the axis of the talus and the I metatarsal bone, between the axis of the talus and the calcaneous. These differences did not vary significantly from those of patients operated before 24 months of age. Conclusions: The surgical treatment of congenital clubfoot deformity, using the peritalar release technique through a Cincinnati approach presented favorable results in 91% of the patients, with no statistically significant differences between patients operated under the age of 24 months or older than 24 months. Future studies with a longer follow-up period are necessary to determine if these differences may pose deterioration in functional results over time.