[Distal intra-articular resection of the calcaneus in the treatment of severe or recurrent congenital clubfoot].

INTRODUCTION

Secondary adaptive bone changes and joint distorsions in clubfoot may present a barrier to adequate correction of the deformity. The purpose of our study is to show how the lateral excision of the calcaneus distal part as described by Lichtblau, in combination with an appropriate medial release allows better correction of forefoot deformity, with less recurrence rate.

MATERIAL AND METHODS

Between 1974 and 1982, 43 feet in 38 patients underwent this type of surgery. Lateral excision o the calcaneus was decided preoperatively in 34 feet, for recurrence of the forefoot deformity following previous surgery. In the remaining 9 feet, this lateral excision was decided intraoperatively, because of an uncomplete correction of the fore part of the foot, despite an adequate posteromedial release. The resected angle from the distal intra-articular part of the calcaneus varied from 10 to 30 degrees with an average of 15 degrees.

RESULTS

All our results were evaluated at end of growth. Mean age at follow-up was 15 years and 4 months, with an average period of 10 years and 7 months following surgery. The average forefoot adduction moved from 21 degrees preoperatively to 1 degree at last follow-up. The clinical calcaneocuboid mobility was preserved in 37 cases. Four types of complications were encountered in 7 patients: pain in 5 cases, calcaneocuboid fusion in 6 cases, recurrence of deformity in 2 cases, and overcorrection in 5 cases; this last complication was related to intraoperative overcorrection rather than a progressive deterioration of the result, and had no clinical significance. No overcorrection was seen after calcaneocuboid fusion. We have found no relation between age at surgery, and the incidence of calcaneocuboid fusion, but the two cases operated on children under one year old, ended up with a bad result.

DISCUSSION

The resection of a single side of a joint may permit normal joint function to be retained. The resected cartilage is replaced by a fibrocartilage that resembles the original articular cartilage, provided the resected defect is deep enough to allow vascularization from the underlying bone.

CONCLUSION

The success of this method depends on an accurate surgical technique, as described by its promoter. It can be of great help in severe and complicated clubfeet. It achieves the goal with a calcaneocuboid function often preserved.