Positioning diagnosis and surgical treatment of the recurrent clubfoot in children

Objective To investigate the positioning diagnose and the efficacy of surgical treatment of the recurrent clubfoot in children.Methods Since 2002,18 patients with 26 recurrent clubfeet were treated at this center.Patients were grouped into 3 groups according to the Davidson's method of clubfoot classification criteria:Group A was simple forefoot adduction (8 cases,10 feet);Group B was stiffness of the midfoot supination and forefoot adduction,which was also called bean-shape foot (8 cases,13 feet);Group C was rigidity deformity of the hindfoot inversion and plantar flexion,and forefoot adduction (2 cases,3 feet).The group A patients underwent anterior tibial tendon transfer or cuboid bone lateral closed wedge osteotomy combined with opening wedge medial cuneiform osteotomy.The group B patients were performed wedge cuboid osteotomy.The Group C patients underwent the calcaneal osteotomy and soft tissue release and anterior tibial tendon transfer,or were applied Ilizarov external fixators to correct the malformation gradually.The patients were followed up from 18 to 70 months (average follow-up period,30 months).Surgical efficacy was assessed using International Clubfoot Study Group score (ICFSG).Results According to the ICFSG score,10 feet of 8 patients were excellent,10 feet of 6 patients good,2 feet of one patient fair,and 1 foot was poor.The last 3 fair or poor scored feet were the patients' in Group C,of which the deformities was corrected but stiffness of ankle and subtalar joints didn't improved after surgery.Conclusions Preoperative positioning diagnosis is necessary and important for choosing proper surgical procedures for recurrent clubfoot in children. Key words: Equinovarus; Orthopedic procedures