Survey of the POSNA Membership Reveals Variability in Use of Tibialis Anterior Tendon Transfer for Recurrent Clubfoot.

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Abstract

[Indexed for MEDLINE] 17. Foot (Edinb). 2020 Dec;45:101721. doi: 10.1016/j.foot.2020.101721. Epub 2020 Jul 25. Ponseti method in the treatment of post-operative relapsed idiopathic clubfoot after posteromedial release. A short term functional study. Al-Hilli AB(1). Author information: (1)College of Medicine University of Baghdad, Iraq; Consultant Orthopedic Surgeon, Medical City, Baghdad, Iraq. Electronic address: ali.alhilli@yahoo.com. BACKGROUND: Relapsed clubfeet deformity after surgical treatment by posteromedial release are frequently encountered in pediatric orthopedic practice and further revision surgery may be needed. As surgery adds more fibrosis and scaring, complication may be devastating and treatment is challenging. Ponseti method, the gold standard technique for treatment of clubfoot may be of a value in the management of postoperative relapses. AIM OF THE STUDY: Determine the effectiveness of Ponseti casting Method in treatment of relapsed idiopathic clubfoot in children after being treated with surgical posteromedial release. MATERIALS AND METHODS: Prospective interventional study of 17 patients (25 feet) presented with a relapsed idiopathic clubfoot deformity after previous surgical posteromedial release. The patients were reviewed using Pirani and Dimeglio score. Ponseti method was done to obtain supple, flexible foot rather than a fully corrected foot, the residual deformity were treated by, heel cord lengthening or tenotomy, tibialis anterior transfer, follow up was for a minimum of 12 months. RESULT: 17 Patients (25 feet) their age ranging from 1 to 10 years were evaluated and treated. Casts were applied until the only deformities remaining were either hindfoot equinus and/or dynamic supination. 22 feet required a heel cord procedure for equinus and 13 required tibialis anterior transfer for dynamic supination. The follow up (average 56.1 months) was for a minimum of one year. 4 feet had persistent heel varus deformity which required Calcaneal osteotomy later. Three feet didn't need more casting and 2 feet were resistant cases that required further Ilizarov procedure, 4 needed lateral arch shortening and other 4 needed posterior capsulotomy. Improvement in the Pirani and Dimeglio scores was highly statistically significant. CONCLUSION: Ponseti method for treatment of relapsed clubfeet after a previous posteromedial soft tissue surgical release is an effective, non invasive, with excellent results. Copyright © 2020 Elsevier Ltd. All rights reserved. DOI: 10.1016/j.foot.2020.101721