Assessment of the Outcomes of Double Column Osteotomy in Treatment of Residual Forefoot Adduction in Clubfoot

Abstract

Background: Following clubfoot surgery, the most frequent remaining deformity is forefoot adduction. For moderate to severe occurrences of this malformation, surgery is frequently necessary. Aim of the study: The study aimed to evaluate the outcomes of double column Osteotomy in treatment of residual forefoot adduction in clubfoot to reach better management plan for treating this residual deformity. Patients and methods: Twenty children (25 feet) with idiopathic clubfeet between 3-7 years of age were analyzed clinically and radiographically. All of the cases were treated by double column osteotomy with soft tissue releases (plantar fasciotomy and abductor hallucis release). Preoperative measurements of certain foot angles were compared with their postoperative values. Results: 11 feet (44%) had excellent, ten (40%) had good, three (12%) had fair, and one (4%) had poor outcome. Pain disappeared in almost all cases except two who had mild pain. The forefoot adduction was fully corrected except five cases in which it was partially corrected. Hindfoot varus was corrected in all cases except three cases. Supination deformity improved in all cases. Cavus deformity improved in all cases except four cases. Tolerability to footwears/orthoses improved in all cases except three who showed batter tolerability but not optimum. The radiographic foot angles measures improved in all cases at least better than their preoperative measures. There was no major complication. Conclusion: Double column osteotomy is a safe operation can be consdidred superior to other types of bone surgeries in correction of the adduction, cavus and rotational deformities in idiopathic clubfoot.