The neglected clubfoot: a salvage procedure

The study included 18 patients (28 feet), between 4 and 14 years of age. Complete homogeneous correction of the neglected clubfoot was achieved by performing a trapezoid resection osteotomy from the cuboid bone after performing an extensive posteromedial soft-tissue release. The procedure did not sacrifice any articular cartilage and allowed realignment of the forefoot. Tibialis anterior tendon transfer to the cuboid was performed in all feet to eliminate its deforming action and to help maintain the desired degree of correction. A Dwyer calcaneal lateral closing wedge osteotomy was needed in 12 feet and was performed concomitantly with the other procedures. After an average follow-up of 26 months (range 8-31 months) 14 (50%) feet had a good result with normal features, 11 (39.3%) feet had a fair result with definite improvement, and three (10.7%) feet had a poor result with limited improvement. Both good and fair results were considered satisfactory. Patients with tight ligaments were significantly more likely to have a poor outcome (p < .0005). However, neither the patient's age at the time of surgery nor the severity of the deformity was significantly associated with unsatisfactory results. The procedure is strongly recommended in supple feet with resilient ligaments, even in teenagers with severe deformity. In severely deformed rigid feet, the procedure serves to minimize bone resection, thus preventing excessive shortening of the foot if a triple arthrodesis should become necessary at a later date.