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Forefoot Adductus Correction in Clubfoot Deformity with Cuboid-Cuneiform Osteotomy

A Retrospective Analysis

Daniel K. Lee, DPM ^* , Marc Benard, DPM , Nicholas Grumbine, DPM , Mitchell Pokrassa, DPM  and Stan Weinstein, DPM 

^* Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA.
Baja Project for Crippled Children, Torrance, CA.

Corresponding author: Daniel K. Lee, DPM, Department of Orthopaedic Surgery, University of California, San Diego, 350 Dickinson St, MC 8894, San Diego, CA 92103.

Abstract

Background: Forefoot adduction is the most common residual deformity in the treatment of pediatric clubfoot. Little documentation exists regarding its late occurrence and early detection. A retrospective analysis was conducted to determine the effect of primary posterior medial release for idiopathic clubfoot that had failed to improve with conservative treatment or had presented after a treatment delay and a subsequent forefoot adduction correction with a cuboid-cuneiform osteotomy.

Methods: Radiographic evaluations were conducted of all of the surgical procedures performed at our institution for idiopathic clubfoot during a specified period. Preoperative and postoperative talo–first metatarsal and talocalcaneal angles were measured radiographically. Of 138 patients with clubfoot deformity who met the inclusion criteria, 51 underwent a primary posterior medial release; of these patients, 18 (26 feet) underwent a subsequent cuboid-cuneiform osteotomy.

Results: The average preoperative and postoperative talo–first metatarsal anteroposterior angles for patients who underwent primary posterior medial release were 44.6° and 26.8°, respectively. The mean reduction in forefoot adduction was 17.8° (P < .05). After the osteotomy, the average talo–first metatarsal anteroposterior angle was 16°, with an average reduction of 10.8° (P < .05). Mean follow-up was 61.2 months. The average patient age was 3.2 years.

Conclusions: Eighteen (35%) of 51 patients who underwent a posterior medial release required a subsequent cuboid-cuneiform osteotomy. The average reduction of 10.8° was statistically significant and has also proved to be clinically significant in the overall correction of the deformity. (J Am Podiatr Med Assoc 97(2): 126–133, 2007)