1. Combined Lateral and Transcuneiform without Medial Osteotomy for Residual Clubfoot for Children.
- Author
-
Arjandas Mahadev, Ismail Munajat, Azura Mansor, and James Hui
- Subjects
CLUBFOOT ,FOOT surgery ,OSTEOTOMY ,FOOT abnormalities ,SUPINATION ,FOOT movements ,FOOT radiography ,DISEASES ,PEDIATRIC surgery ,THERAPEUTICS - Abstract
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° (from 40° to 12°) and by 11° (from 21° to 10°). The supination improved by 11° (from 19° to 8°) and the cavus improved by 17° (from 30° to 13°). 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 of Evidence: Level IV, therapeutic study (case series). See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF