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Surgical management of resistant idiopathic congenital clubfoot.

For neglected clubfeet or clubfeet resistant to conservative treatment, there is an increasing tendency towards early and tailored release. From November 1983 to November 1987, we operated on 37 children with 53 neglected or resistant clubfeet which included 23 with limited release and 30 with radical release. Their ages ranged from 4 months to 8 years with an average age of 1 year 5 months. Operative treatment was indicated if the clubfeet had been neglected or had shown no corrective change after 12 weeks of intensive plaster treatment. We used the Cincinnati incision for one-stage release. The average follow-up was 3.5 years (range 2-5.5 years). Evaluation criteria included physical, functional and roentgenographic findings. The results were good or excellent in 96% of the feet based on the modified Magone rating scale. There was no significant difference in the operation results between different age groups. Both the limited and the radical release groups had a high rate of satisfaction. The limited procedure only effectively improved the tibio-calcaneal angle to a significant degree (p less than 0.01), while the radical operation changed every angle significantly (p less than 0.01). Complications included calf muscle atrophy in 4 feet, overcorrection in 3 feet, undercorrection in 3 feet, superficial skin necrosis in one foot, pin tract infection in one foot and residual metatarsal adductus in one foot. In conclusion, neglected or resistant clubfeet can be treated by early and adequate release with a high rate of success. Complications can be avoided by a thorough understanding of their pathoanatomy and by a meticulous surgical approach and release.