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

Abstract

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.