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Journal of Bone and Joint Surgery, 1971;53:477-497.
© 1971 by The Journal of Bone and Joint Surgery, Inc

Surgical Correction of the Resistant Club Foot

ONE-STAGE POSTEROMEDIAL RELEASE WITH INTERNAL FIXATION: A PRELIMINARY REPORT

VINCENT J. TURCO M.D.1

1 From the Department of Orthopaedic Surgery, Saint Francis Hospital, Hartford

A method is described for the early one-stage surgical correction of the resistant, idiopathic, congenital club foot that has failed to respond to non-operative treatment, or has recurred following previous soft-tissue surgery. The method is derived from the procedures previously described by, among others, Codivilla, Brockman, McCauley, and Bost.

Of the thirty-one feet which have been followed two years or more postoperatively, one was a failure necessitating further surgery, three were considered to be fair results and the rest were rated good or excellent by rigid clinical and roentgenographic criteria.

Based on the preoperative roentgenographic and clinical findings, as well as the operative findings in this small series, it is concluded that (1) a complete correction is best attained with a one-stage posterior and medial soft-tissue release, (2) a lasting corrections is attained only if the correction at operation is complete and temporarily stabilized by internal fixation, and (3) a stress dorsiflexion lateral roentgenogram is the most accurate and reliable method of assessing the correction of the deformity.

The technique described has obviated the problems with wound healing, postoperative stiffness, and recurrent deformity which, in the past, have been raised as objections to early soft-tissue surgery.

Despite the fact that many of the feet in this series have not been followed until they were skeletally mature, the results to date indicate that a lasting correction can be obtained by a one-stage operation in which the correction is stabilized by transfixing the talonavicular joint with a Kirschner wire and that the best results are obtained when the operation is performed when the child is under two years of age.


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