Abstract
Introduction: Recurrence is by definition the development of one or more of the original deformities (equinus, varus, adductus and cavus) after the full correction of the clubfoot is obtained. Adduction of the forefoot is the most common residual deformity in clubfoot associated with supination of the foot [Tarraf and Carroll]. Under correction at the time of initial surgery, medial displacement of the anterior part of calcaneum and navicular bones around the talus were considered to be some of the causative factors. Aims & objectives: To analyse the effectiveness of the combined cuboid /cuneiform osteotomy for correction of residual forefoot adduction deformity in idiopathic clubfoot. To study the improvement in forefoot flexibility, gait and overall functional outcome. To study the advantage of this procedure over other techniques of osteotomy. Materials and methods: 16 cases (feet) in 11 children, who presented to our institution (Government Rajaji Hospital, Madurai) between November 2010 and November 2012 with residual forefoot adduction deformity. Children were followed up for a period 2 years. Ethical committee approval was obtained for the procedure. The mean age at the time of surgery was 6.5 years (range 3- 10 years). There were 7 boys (10 feet), 4 girls (6 feet). The right foot in 9 children and left foot in 7. Results: Results according to point scoring system: (modified Bensahel et al.) approved by the International clubfoot study group. Of the 16 feet treated, 8 feet (50%) had excellent results, 5 feet (32%) good, 2 feet (12%) fair and 1 foot (6%) poor results. Conclusion: The combination of a shortening osteotomy of the cuboid and elongation of the cuneiform was first described by Mc hale and Lenhart. The combined osteotomy is a safe procedure and allows satisfactory correction of the residual forefoot adduction deformity and achieving a straight plantigrade foot.
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