Forefoot adductus correction in clubfoot deformity with cuboid-cuneiform osteotomy: a retrospective analysis.

Background: Forefoot adduction is the most common residual deformity in the treatment of pediatric clubfoot. Little documentation exists regarding its late occurrence and early detection. A retrospective analysis was conducted to determine the effect of primary posterior medial release for idiopathic clubfoot that had failed to improve with conservative treatment or had presented after a treatment delay and a subsequent forefoot adduction correction with a cuboid-cuneiform osteotomy.

Methods: Radiographic evaluations were conducted of all of the surgical procedures performed at our institution for idiopathic clubfoot during a specified period. Preoperative and postoperative talo-first metatarsal and talocalcaneal angles were measured radiographically. Of 138 patients with clubfoot deformity who met the inclusion criteria, 51 underwent a primary posterior medial release; of these patients, 18 (26 feet) underwent a subsequent cuboid-cuneiform osteotomy.

Results: The average preoperative and postoperative talo-first metatarsal anteroposterior angles for patients who underwent primary posterior medial release were 44.6 degrees and 26.8 degrees , respectively. The mean reduction in forefoot adduction was 17.8 degrees (P < .05). After the osteotomy, the average talo-first metatarsal anteroposterior angle was 16 degrees , with an average reduction of 10.8 degrees (P < .05). Mean follow-up was 61.2 months. The average patient age was 3.2 years.

Conclusions: Eighteen (35%) of 51 patients who underwent a posterior medial release required a subsequent cuboid-cuneiform osteotomy. The average reduction of 10.8 degrees was statistically significant and has also proved to be clinically significant in the overall correction of the deformity.