Congenital clubfoot in children after walking age: management and evaluation of 41 feet with the dimeglio score.

Abstract

Congenital Clubfoot (CC) is one of the most frequent orthopedic lesions in patients younger than 10-15 years. The surgical correction is more difficult in children over 1.5 years, compared to newborns, due to advanced osteoarticular development and higher rigidity of the foot. The aim of this study was to report the results of our experience regarding the combined orthopedic-surgical treatment of CC and the follow-up prognostic value of Dimeglio score in children aged between 1.5 to 12 years. From June 2009 and May 2012, 31 consecutive patients with CC, aged between 1.5 to 12 years, underwent surgical treatment. To assess the results, pre-operative and post-operative Dimeglio scores, at 6 months after surgery, were compared in each of the cases. An adapted Ponseti-Mitchelle orthosis-bar was used for aftercare. The mean age of patients enrolled in this study was 4.32±2.04 years old. From the 31 patients, 10 had bilateral deformity; surgical intervention was performed for a total of 41 feet. Independently by the age of patients, between pre-operative and post-operative evaluation, the Dimeglio score regressed from a mean of 11.70±7.43 (ranged between 4 and 18) to 3.80±0.96 (ranged between 0 and 12). Unfavorable outcome was observed in 5 feet; the success correction rate was 85.37%. This study reveals that CC can also be treated in older children by using a proper orthopedic, surgical and post-operative management. The Dimeglio score is useful, easy to use and relevant also in children over 1.5 years.