Congenital clubfoot: pathomechanics, Radiographic analysis, and results of surgical treatment.

Twenty-one patients with resistant or relapsed clubfeet, ranged in age from four months to 7 years, and all had initially been treated with plaster by board certified orthopaedic surgeons. Surgery was recommended only after an Achilles tenotomy failed to bring the foot into dorsiflexion after approximately four months of age. Surgical correction was based upon the derotation and dorsiflexion of the talus in the ankle mortise. The criteria for a satisfactory result were: no recurrence of the equinus or varus; neutral position of the heel; dorsiflexion of the ankle to at least neutral; a fairly straight forefoot so that the center line of the foot bisected either the second or third toes or passed no further laterally than the third and fourth toes. Of the 33 feet surgically treated, 28 had satisfactory results following the first procedure, and five required additional procedures.