Combined Cuboid-Cuneiform Osteotomy For Correction Of Residual Forefoot Adduction Deformity In Idiopathic Clubfoot

Abstract

Background: Residual forefoot adduction deformity refers to the persistent inward deviation of the forefoot in patients following corrective procedures for idiopathic clubfoot, with reported incidence rates varying up to 95%. Aims and objectives: To evaluate the clinical and radiological results of combined cuboid-cuneiform osteotomy for correcting the residual forefoot adduction deformity of idiopathic clubfoot patients.Materials and methods: Eighteen cases (feet) in 13 children with residual forefoot adduction deformity were treated between October 2022 and September 2023 at the Orthopedic Department of Zagazig University Hospital in Egypt. The children were followed up for at least six months, and all cases underwent a combined cuboid-cuneiform osteotomy with soft tissue releases. Measurements including the anterior talocalcaneal angle (TCA1), anterior talo-first metatarsal angle (TFMA1), calcaneo-fifth metatarsal angle (CFMA), lateral talocalcaneal angle (TCA2), and lateral talo-first metatarsal angle (TFMA2) were taken pre-operatively and post-operatively.Result: The residual forefoot adduction deformities were evaluated clinically and radiologically according to a scoring system modified by Bensahel et al. and supported by the International Clubfoot Society. Based on the total calculated score, the results were categorized into four levels: excellent, good, fair, and poor. Fifty percent of the treated feet had excellent results, 33% had good results, 11% had fair results, and 6% had poor results. Despite nonsignificant complications, 16 patients expressed satisfaction with the operation.Conclusion: Combined cuboid-cuneiform osteotomy is a safe and effective option for correcting residual forefoot adduction deformity in idiopathic clubfoot, resulting in a straight plantigrade foot.