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

Abstract

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 degrees (from 40 degrees to 12 degrees ) and by 11 degrees (from 21 degrees to 10 degrees ). The supination improved by 11 degrees (from 19 degrees to 8 degrees ) and the cavus improved by 17 degrees (from 30 degrees to 13 degrees ). 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. Level IV, therapeutic study (case series). See Guidelines for Authors for a complete description of levels of evidence.