Management of the resistant idiopathic clubfoot: the Kaiser experience from 1980-1990.

Sixty-three congenital idiopathic clubfeet were clinically and radiographically evaluated following a single Turco-type complete posteromedial soft tissue release with internal fixation. Average age at the time of surgery: 12.4 months; average postoperative follow-up: 67.2 months. A new rating system that weighs dynamic functional results more heavily was used to compare our findings. The results were rated as excellent in 29 feet (46%), good in 15 feet (24%), fair in 8 feet (13%), and poor/failures in 11 feet (17%). Ninety-five percent of the parents were satisfied with the current results, although 59% felt that their child would have physical limitations in the future. Clinical complications included the following residual deformities: hindfoot varus (3.2% or two feet), equinus (3.2% or two feet), cavus (22.2% or 14 feet), and forefoot adductus (41.3% or 26 feet). The bimalleolar axis in the 63 clubfeet averaged 74.9 degrees. No calcaneus gaits were present. Radiographic complications included both over-correction (1.6% or one foot) and under-correction (4.8% or three feet) of the talonavicular joint articulation, avascular necrosis of the navicular, (14.3% or nine feet), talus (4.8% or three feet), and calcaneus (1.6% or one foot). Thirty-three feet (52.4%) revealed some degree of abnormal talar dome flattening, 22 feet (34.9%) revealed navicular dorsal subluxation or "wedging." Only 37 (58.7%) exhibited normal talonavicular joint congruity.