A New Eclectic Open Surgical Management of Recurrent, Residual, or Neglected Clubfoot in Children. An update on old and new in the field

Abstract

All patients with clubfoot, regardless of age, are treated by the Ponseti or Bensahel technique as the first conservative therapeutic method. These techniques have greatly increased the success rate, which still remains at a good level even if the recurrence rate has recorded an increase from 5% to 40%. Thus, interventions for medial and dorsal release have also increased in number. When the decision to treat complications is resumed, it is good to start with one of these methods to ensure tissue flexibility and consolidate favorable outcomes.

The purpose of this study was to present a new eclectic technique and to analyze the outcomes of medial and dorsal release using this surgical technique for recurrent, residual, or neglected clubfoot in children 6 months to 8 years of age. This was a project study that analyzed statistical data from three graduation theses. All patients included in the study were personally operated on in two periods of time as follows: 2008-2016, in public clinics, and 2018-2022, in private clinics.

The preoperative evaluation was performed after completion of the Ponseti or Bensahel technique and consisted of an X-ray examination (CT and 3D-CT). After this scan, those who needed CT and MRI were selected.

Radiologically measured talonavicular-cuneometatarsal 1 alignment was invariably fixed on the splint within the talus range and restored the tibial radius of the foot. The plantar arch was normal, and the talocalcaneal divergence in the coronal and sagittal planes was within normal limits.

The mentioned results showed an excellent correlation between the plantar arch configuration and the three essential clinical elements of the foot: shape, direction, and position. In the support phase, the operated foot moves normally from the contact point on the calcaneus to the digital support phase. Comparison with the normal foot indicated a similarity of 89%, meaning 25 out of 28 feet. The properly aligned and reconfigured tibial (medial) radius of the foot allows the biomechanics of the foot to regain a mobility pattern that is almost similar to that of the normal foot.

Keywords: medial and dorsal release, transposition of plantar insertions of the tibialis posterior to the navicular, syndesmolysis, musculoaponeurotic plantar disinsertion, reconfiguration of the plantar arch on the talonavicular-cuneometatarsal 1 splint