Surgical Correction of Neglected Clubfeet in the elder Child and Adult

Clubfoot or talipes equinovarus is the most common congenital anomaly of the foot observed in children as well as in adults. This deformity should be treated immediately after birth, and so the cases of old neglected clubfeet are quite rare now. Moreover, in the cases of old neglected clubfoot, it is very difficult to get satisfactory results because there will be secondary adaptive changes in the tarsal bones and surrounding soft tissues. Therefore, clubfeet are considered to be one of many things requiring on or more of the many different types of treatment. The authors have experienced to treat nine cases of old neglected clubfoot from May, 1978 to April, 1988 at the Department of Orthopedic Surgery, St. Mary's Hospital, and reported herewith. 1. Their average age was 14.8 years old (3 to 25 yesrs old). There were one bilateral clubfeet, left foot in 5 cases and right foot in 4 cases. 2. According to the age of the patients and severity of deformities, two patients from three to ten years old were treated with soft-tissue release and serial casting, and seven patients after ten years old were treated by soft-tissue release, various osteotomies and triple arthrodesis. Postoperative management consisted of long leg cast for first four weeks and short leg walking cast for another four to eight weeks. 3. The results were estimated by the talo-calcaneal index according to Beatson et al(3)radiologically and their external appearance of corrected foot subjectively. The talo-calcaneal index was improved from 17.8° to 37° after operation and all of patients satisfied with the results of their operation.