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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109
Volume 10, Issue 3, April 2014 pp 486-491
The Results of Posteromedial Release in Clubfoot below the Age of 3 Years
Ronald Joseph Menezes1, Rakesh Sera2
1Associate Professor, 2PG Resident
Department of Orthopaedics, Father Muller Medical College, Kankanady, Mangalore – 575 002, Karnataka, INDIA.
Academic Editor : Dr. Aher K.R.
Specific objectives: Congenital Talipes Equinovarus (Clubfoot) is one of the most common foot anomalies which can be treated by serial casting technique with high rate of success. Surgery is indicated for deformities that do not respond to conservative treatment or the patients that seek medical intervention too late. In this study, we reviewed the results of posteromedial release in clubfoot below 3 years. Materials and methods: Between May 2009 to June 2013, we treated sixty four feet (64) with idiopathic CTEV in forty (40) children who were below 3 years, who were evaluated and operated using posteromedial release in Father Muller Medical College Hospital, Mangalore. All the feet were given a trial of serial manipulation and cast application till the deformities were no more correctable. Medial release was done with the separate incision, only when full correction could not be obtained with posterior release. Sutures were removed after 15 days followed by manipulation and cast application. Postoperative cast immobilization continued for 2 months in an over corrected position, followed by immobilization with CTEV splint and CTEV shoe. At the end of 6 and 12 months all the feet were evaluated according to the modified Wynne – Davies Scoring system. Results: All 64 feet were operated between ages of 3 months to 18 months with a mean age of 8.4 months. Out of the 64 feet 10 feet required only posterior release whereas rest of the 54 feet required posterior and medial release. Postoperatively the patients were followed up for a minimum of 12 months to a maximum of 48 months with a mean of 30 months. Post-Operative evaluation was done according to the total score obtained by the modified Wynne – Davies Scoring system. According to this, 40 feet were evaluated as excellent, 12 were good, 4 were fair and 8 were poor. 22 patients had residual deformity. Among the residual deformities noted, forefoot adduction was by far the commonest and hindfoot varus came next. Gait was considered normal in 22 feet only. Among 64 feet assessed, 4 feet were regarded as poor on clinical grounds. All 4 had residual deformities i.e Forefoot adduction, hindfoot varus and hindfoot equinus. All relapsed cases were treated by JESS application with gradual stretching and correction of the deformity. All except one feet showed good results following this procedure. Conclusion: The timing of surgery did not change the final outcome considerably below 3 years of age in clubfoot. With posterior and posteromedial release 81.25 percent of cases had excellent to good results. Importance should be given to adequate soft tissue release and immediate post-operative splinting for obtaining good result. Relapses did not occur in 2 year follow-up period, in those cases, where good correction was obtained initially. Mild forefoot adduction was the commonest residual deformity, which did not lead to any functional outcome. Controlled differential fractional distraction by the application of JESS is more suitable for the correction of relapsed cases, than second surgical procedures. Since we treated only 4 cases by this method, it is difficult to comment on the final outcome