Ankle range of motion following surgical correction of early relapse in clubfoot.

Abstract

Surgical options for relapsed clubfoot include repeat heel cord lengthening or posterior release for recurrent equinus, and anterior tibialis tendon transfer (ATT) for residual dynamic supination deformity. Some studies have suggested that these procedures be performed in isolation to allow for early range of motion after intra-articular surgery. This study was performed to examine clinical and radiographic outcomes comparing two surgical methods, simultaneous ATT with posterior release (ATT/PR) vs ATT performed in isolation (ATT(i)), for the management of recurrent clubfoot deformity. Patients who underwent ATT(i) and ATT/PR for relapsed clubfoot deformity after initial Ponseti casting, were 2-20 years old at time of surgery, and had postoperative range of motion (ROM) data, pedobarographic data, and radiographic results with minimal follow-up of 1 year were included. A total of 49 patients (69 feet) were reviewed. Mean age at time of surgery was 4.4 (SD 1.73) years. Of the 69 feet, 27 received ATT(i) and 42 received ATT/PR. No difference in the ROM outcome of ankle dorsiflexion was found between ATT(i) vs ATT/PR at a mean of 5.8 years follow-up. In patients undergoing ATT(i), there was a mild increase in lateral loading of the foot compared to those feet having ATT/PR. Follow up radiographic results for both groups were in the normal range, with less residual radiographic equinus in the ATT/PR group. ATT(i) or ATT performed along with intra-articular posterior capsular release offers comparable short-term outcomes. Level of evidence. This study was a retrospective case series, Level IV.