Treatment of Adduction Deformity in Relapsed Clubfoot: A New Mini Invasive Technique

Antonello Montanaro, MD, Rome, Italy
Luca Labianca, MD, Rome, Italy
Francesco Turturro, MD, Rome, Italy
Russalka Hoedemaeker, MD, United States贵阳市妇幼保健院儿外科陈后平
Cosma Calderaro, Rome, Italy
Vincenzo Di Sanzo, MD, Rome, Italy
Andrea Ferretti, Rome, Italy

INTRODUCTIONAdduction of the forefoot is the most common deformity in relapsed clubfoot. It may cause functional disability. Adduction is caused by a length inequality between the medial and the lateral column of the foot. Several techniques have been described to correct this inequality. Known complications of these, often difficult, surgical procedures are overcorrection, stiffness and arthritis. Therefore we developed a new technique using an eight plate and performing a temporary arthrodesis of the calcaneus-cuboid joint to compensate with growth the length difference between the medial and lateral column.
METHODSWe selected 10 patients with relapsed clubfoot presenting mild adduction deformity; all patients underwent temporary arthrodesis of the calcaneus-cuboid joint by a guided-growth treatment with the eight-plate device. Radiological controls were planned before surgery and then at first, third and every four months until correction was satisfying. Talus-I metatarsus angle and calcaneus-IV metatarsus angle were evaluated.
RESULTSIn all cases full correction was obtained, with a significant improvement (p<0.05) of both measured angles.The eight-plate was then removed. At three-year follow up, none of the patients presented overcorrection or relapse of the deformity. All patients had good function.
DISCUSSION AND CONCLUSIONThis is a minimally invasive technique that does not require casting and allows immediate post-operative weight bearing. An eight plate device was used to perform a temporary arthrodesis of the calcaneus-cuboid joint to manage the length difference between medial and lateral column. This avoids the need to perform subsequent surgeries to correct a deformity over time. Our preliminary results suggest that this new technique can be a valid alternative in selected cases.