Medium-term results of single-stage posteromedial release and triple arthrodesis in treatment of neglected clubfoot deformity in adults.

Objective: This study aimed to evaluate the implementation, in a single session, of both massive posteromedial release and triple arthrodesis for rigid neglected clubfoot deformities in adult patients, and its effects on clinical and radiological results.

Methods: The procedures were performed in one session on 15 feet of 11 patients [7 male, 4 female; mean age 26 (range: 15 to 50)]. Staples were used for fixation in all patients. For clinical assessment, the AOFAS (American Orthopaedic Foot and Ankle Society) ankle- hindfoot scale was used. Anteroposterior/lateral side talocalcaneal and talus-1st metatarsal angles were used as radiographic parameters. The mean follow-up was 7.5 years (range: 6 to 11).

Results: The mean AOFAS score rose from a preoperative 39 (range: 15 to 52) to 88 (range: 76 to 94) in the final follow up (p<0.0001). Among the 15 feet, 9 were evaluated as excellent, 5 as good, and 1 as fair. Significant clinical improvement was obtained between preoperative and postoperative surgical periods (p<0.05). Significant improvements were observed in radiographic parameters (p<0.0001). At final follow-up, radiographic values were within normal physiological limits. Average union time was 12.4 (range: 7 to 36) weeks. While pseudoarthrosis was not observed in any patients, delayed union developed in 2 cases, and talus avascular necrosis in 1. In the preoperative period, 5 patients had various degrees of degenerative changes. Nine patients developed degenerative changes in different joints and of different degrees.

Conclusion: The authors believe that massive soft tissue release and triple arthrodesis performed in a single session yields satisfactory results cosmetically and functionally in neglected clubfoot cases with severe deformities.