Evaluation of Foot Osteotomies for Treating Residual Clubfoot Deformities in Ambulatory Children With Arthrogryposis.

INTRODUCTION

Clubfoot is the most common deformity seen in children with arthrogryposis. The primary method of treatment for this deformity is serial casting, which has a greater frequency of incomplete correction and recurrence than in idiopathic clubfoot. For both primary and recurring cases, surgical treatments vary from soft-tissue releases to talectomy. This research aimed to evaluate the effectiveness of bony surgical procedures in correcting clubfoot in ambulatory children with arthrogryposis.

METHODS

The study retrospectively examined ambulatory children with arthrogryposis, all of whom had at least 1 osteotomy procedure on their clubfoot. The treatment's effectiveness was assessed using passive range of motion (PROM), dynamic foot pressure, and the pediatric outcomes data collection instrument (PODCI) utilizing paired t tests. The frequency of subsequent bone surgeries following the initial operation was documented.

RESULTS

The study reviewed 20 children who had 49 surgical procedures performed on 24 feet at age 15.1±4.5 years. PROM revealed enhanced ankle dorsiflexion and forefoot abduction ( P <0.05). In addition, evaluating dynamic foot pressure, coronal plane pressure index (CPPI), and the timing of heel rise demonstrated significant improvement ( P <0.05). PODCI demonstrated improvement in transfer basic mobility (from 80.57±17.31 to 86.50±13.46) and global function (from 69.64±15.03 to 74.50±13.91) ( P <0.05). Pain (from 69.58±25.39 to 79.21±26.57; P =0.067) and happiness (from 70.68±27.66 to 79.32±20.02; P =0.052) also improved and approached statistical significance. Moreover, a CPPI of <-94 was found to be predictive for suggesting the necessity of external fixator use according to the receiver operating characteristic analysis done based on our findings (area under the curve: 0.79, P= 0.0007). Two children required an additional procedure at 26-months and 37-months postindex surgery because of residual equinus deformity and insufficient correction of forefoot adduction, respectively.

CONCLUSION

This research highlights the substantial role surgical procedures can play in improving ankle PROM, hindfoot-forefoot alignment, dynamic foot position, and functional mobility in children with clubfoot secondary to arthrogryposis. It establishes a basis for future inquiries to delve into the longevity of these benefits and the overall outcomes.

LEVEL OF EVIDENCE: Level III-retrospective study.