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Title: Combined lateral and transcuneiform without medial osteotomy for residual clubfoot for children
Authors: Mahadev, A.
Munajat, I.
Mansor, A. 
Hui, J.H.P. 
Issue Date: May-2009
Citation: Mahadev, A., Munajat, I., Mansor, A., Hui, J.H.P. (2009-05). Combined lateral and transcuneiform without medial osteotomy for residual clubfoot for children. Clinical Orthopaedics and Related Research 467 (5) : 1319-1325. ScholarBank@NUS Repository.
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. © 2009 The Association of Bone and Joint Surgeons.
Source Title: Clinical Orthopaedics and Related Research
ISSN: 0009921X
DOI: 10.1007/s11999-009-0755-4
Appears in Collections:Staff Publications

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