eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Clubfoot: Follow-up

Author: Minoo Patel, MBBS, MD, MS, FRACS, Senior Lecturer, Monash University, Melbourne, Australia; Consulting Adult/Pediatric Orthopedic Surgeon, Department of Orthopedic Surgery, Monash Medical Center, Melbourne, Australia
Coauthor(s): John Herzenberg, MD, FRCSC, Professor, Department of Orthopedic Surgery, Associate Professor, Department of Pediatrics, University of Maryland Medical School, Codirector of International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore
Contributor Information and Disclosures

Updated: Nov 2, 2007

Outcome and Prognosis

Approximately 50% of clubfeet in newborns can be corrected nonoperatively. Ponseti reports an 89% success rate using his technique (including an Achilles tenotomy). Others report success rates of 10-35%. Most series report 75-90% satisfactory results of operative treatment (appearance and function of the foot). The amount of motion in the joints of the foot and ankle correlates with the degree of patient satisfaction.21,22,23

Satisfactory results were obtained in 81% of cases, and the range of ankle movement was a major factor in determining the functional result, which again was influenced by the degree of talar dome flattening (suggesting that the primary bone deformity present at birth dictates the eventual result of treatment). Forty-four percent of patients had no dorsiflexion beyond neutral, and 38% of patients required further surgery (nearly two thirds of these were bony procedures).

Recurrence rates of deformity were reported at around 25%, with a range of 10-50%. Menelaus reported a 38% recurrence rate.24,25

The best results were obtained with children older than 3-4 months with a foot large enough to perform the surgery without compromise (longer than 8 cm, as specified by Simons26,27 ). The age at operation is directly related to the result. Less than satisfactory results may be associated with overcorrection, which occurs in approximately 15% of cases.

Previous surgery seems to have a deleterious effect on the result.

Future and Controversies

As small infants with operated clubfeet have grown into heavy adults, they have been prone to painful stiff feet, despite good correction.

Deitz and Cooper published a 30-year follow-up study of patients treated with the Ponseti method.28 These cases had comparatively pain-free supple feet. The Ponseti method is gaining mainstream acceptance as evidenced by the emergence of Ponseti clubfeet centers at major teaching hospitals across the United States.

Of the patients who have been monitored long term, those who are heavy and those in jobs involving long periods on their feet (especially performing manual labor) were found to be more likely to have painful feet. This correlated with the trend seen in the general population at large.

 


More on Clubfoot

Overview: Clubfoot
Workup: Clubfoot
Treatment: Clubfoot
Follow-up: Clubfoot
Multimedia: Clubfoot
References
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References

  1. Docker CE, Lewthwaite S, Kiely NT. Ponseti treatment in the management of clubfoot deformity - a continuing role for paediatric orthopaedic services in secondary care centres. Ann R Coll Surg Engl. Jul 2007;89(5):510-2. [Medline].

  2. Ippolito E, Ponseti IV. Congenital club foot in the human fetus. A histological study. J Bone Joint Surg Am. Jan 1980;62(1):8-22. [Medline].

  3. Scher DM. The Ponseti method for treatment of congenital club foot. Curr Opin Pediatr. Feb 2006;18(1):22-5. [Medline].

  4. Hussain FN. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Joint Surg Br. Apr 2007;89(4):561; author reply 561-2. [Medline].

  5. Lejman T, Kowalczyk B. [Results of treatment of congenital clubfoot with modified Goldner's technique]. Chir Narzadow Ruchu Ortop Pol. 2002;67(4):351-5. [Medline].

  6. Kaewpornsawan K, Khuntisuk S, Jatunarapit R. Comparison of modified posteromedial release and complete subtalar release in resistant congenital clubfoot: a randomized controlled trial. J Med Assoc Thai. May 2007;90(5):936-41. [Medline].

  7. Celebi L, Muratli HH, Aksahin E, Yagmurlu MF, Bicimoglu A. Bensahel et al. and International Clubfoot Study Group evaluation of treated clubfoot: assessment of interobserver and intraobserver reliability. J Pediatr Orthop B. Jan 2006;15(1):34-6. [Medline].

  8. Paton RW, Freemont AJ. A clinicopathological study of idiopathic CTEV. J R Coll Surg Edinb. Apr 1993;38(2):108-9. [Medline].

  9. Zimny ML, Willig SJ, Roberts JM, D'Ambrosia RD. An electron microscopic study of the fascia from the medial and lateral sides of clubfoot. J Pediatr Orthop. Sep-Oct 1985;5(5):577-81. [Medline].

  10. Inclan. Anomalous tendon insertions theory, though other studies have not supported this; the distorted anatomy can make it appear that tendon insertions are anomalous. J Bone Joint Surg Am. 1958;40:159.

  11. Robertson. CORR Prenatal polio-like condition; epidemiological evidence,seasonal variation.

  12. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Joint Surg Br. Aug 2006;88(8):1082-4. [Medline].

  13. Hsu WK, Bhatia NN, Raskin A, Otsuka NY. Wound complications from idiopathic clubfoot surgery: a comparison of the modified Turco and the Cincinnati treatment methods. J Pediatr Orthop. Apr-May 2007;27(3):329-32. [Medline].

  14. Singh BI, Vaishnavi AJ. Modified Turco procedure for treatment of idiopathic clubfoot. Clin Orthop Relat Res. Sep 2005;438:209-14. [Medline].

  15. Bensahel H, Csukonyi Z, Desgrippes Y, Chaumien JP. Surgery in residual clubfoot: one-stage medioposterior release "à la carte". J Pediatr Orthop. Mar-Apr 1987;7(2):145-8. [Medline].

  16. Bensahel H, Jehanno P, Delaby JP, Themar-Noël C. [Conservative treatment of clubfoot: the Functional Method and its long-term follow-up]. Acta Orthop Traumatol Turc. 2006;40(2):181-6. [Medline].

  17. Ferreira RC, Costa MT, Frizzo GG, Santin RA. Correction of severe recurrent clubfoot using a simplified setting of the Ilizarov device. Foot Ankle Int. May 2007;28(5):557-68. [Medline].

  18. Freedman JA, Watts H, Otsuka NY. The Ilizarov method for the treatment of resistant clubfoot: is it an effective solution?. J Pediatr Orthop. Jul-Aug 2006;26(4):432-7. [Medline].

  19. Ferreira RC, Costa MT, Frizzo GG, Santin RA. Correction of severe recurrent clubfoot using a simplified setting of the Ilizarov device. Foot Ankle Int. May 2007;28(5):557-68. [Medline].

  20. Graham GP, Dent CM. Dillwyn Evans operation for relapsed club foot. Long-term results. J Bone Joint Surg Br. May 1992;74(3):445-8. [Medline].

  21. Morcuende JA, Abbasi D, Dolan LA, Ponseti IV. Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop. Sep-Oct 2005;25(5):623-6. [Medline].

  22. Ponseti IV. Relapsing clubfoot: causes, prevention, and treatment. Iowa Orthop J. 2002;22:55-6. [Medline].

  23. Ponseti IV. Clubfoot management. J Pediatr Orthop. Nov-Dec 2000;20(6):699-700. [Medline].

  24. Haft GF, Walker CG, Crawford HA. Early clubfoot recurrence after use of the Ponseti method in a New Zealand population. J Bone Joint Surg Am. Mar 2007;89(3):487-93. [Medline].

  25. Dobbs MB, Corley CL, Morcuende JA, Ponseti IV. Late recurrence of clubfoot deformity: a 45-year followup. Clin Orthop Relat Res. Jun 2003;(411):188-92. [Medline].

  26. Simons GW. Calcaneocuboid joint deformity in talipes equinovarus: an overview and update. J Pediatr Orthop B. 1995;4(1):25-35. [Medline].

  27. Simons GW. A standardized method for the radiographic evaluation of clubfeet. Clin Orthop Relat Res. Sep 1978;(135):107-18. [Medline].

  28. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am. Oct 1995;77(10):1477-89. [Medline].

  29. Bohm. Arrest of fetal development in the fibular stage. J Bone Joint Surg Am. 1929;11:229.

  30. Bor N, Herzenberg JE, Frick SL. Ponseti management of clubfoot in older infants. Clin Orthop Relat Res. Mar 2006;444:224-8. [Medline].

  31. Cowell HR, Wein BK. Genetic aspects of club foot. J Bone Joint Surg Am. Dec 1980;62(8):1381-4. [Medline].

  32. Faulks S, Luther B. Changing paradigm for the treatment of clubfeet. Orthop Nurs. Jan-Feb 2005;24(1):25-30; quiz 31-2. [Medline].

  33. Irani RN, Sherman R. Defective cartilaginous anlage of the talus. J Bone Joint Surg Am. 1963;45A:45.

  34. Isaacs H, Handelsman JE, Badenhorst M, Pickering A. The muscles in club foot--a histological histochemical and electron microscopic study. J Bone Joint Surg Br. Nov 1977;59-B(4):465-72. [Medline].

  35. Noonan KJ, Richards BS. Nonsurgical management of idiopathic clubfoot. J Am Acad Orthop Surg. Nov-Dec 2003;11(6):392-402. [Medline].

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Further Reading

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Keywords

congenital talipes equinovarus, CTEV, rockerbottom foot, rockerbottom deformity, foot deformity, clubfeet, clubfoot surgery

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Contributor Information and Disclosures

Author

Minoo Patel, MBBS, MD, MS, FRACS, Senior Lecturer, Monash University, Melbourne, Australia; Consulting Adult/Pediatric Orthopedic Surgeon, Department of Orthopedic Surgery, Monash Medical Center, Melbourne, Australia
Minoo Patel, MBBS, MD, MS, FRACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, AO Foundation, Australian Association of Surgeons, Australian Medical Association, Australian Orthopaedic Association, Orthopaedic Research Society, Orthopaedics Overseas, Pediatric Orthopaedic Society of North America, and Royal Australasian College of Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

John Herzenberg, MD, FRCSC, Professor, Department of Orthopedic Surgery, Associate Professor, Department of Pediatrics, University of Maryland Medical School, Codirector of International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore
John Herzenberg, MD, FRCSC is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Medical Editor

John S Early, MD, Clinical Professor of Orthopedic Surgery, Department of Orthopedics, University of Texas Southwestern Medical School
John S Early, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shepard R Hurwitz, MD, Director of Clinical Services, Department of Orthopedic Surgery, University of Virginia School of Medicine; Director, Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, University of Virginia Health System
Shepard R Hurwitz, MD is a member of the following medical societies: American College of Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, and Orthopaedic Trauma Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FAAOS, Chairman, J Vernon Luck Distinguished Professor, Department of Orthopedic Surgery, University of Missouri
Jason H Calhoun, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, and American Orthopaedic Foot and Ankle Society
Disclosure: Nothing to disclose.

 
 
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