A Comparison of the Long-Term Results of Posterior and Comprehensive Release in the Treatment of Clubfoot

Abstract

Summary: This study compared the long-term results of posterior and comprehensive release in the treatment of clubfoot. Patients were eligible for this study if the clubfoot was idiopathic and treatment was performed before 2 years of age. Medical records were reviewed to obtain the age, sex, bilaterality, and details of surgical treatment. Posterior release (performed before 1971) consisted of Achilles tendon lengthening and posterior ankle and subtalar releases. The comprehensive release, as described by Carroll, was performed after 1972. At the time of final review, patients completed Ponsetti's functional 100-point grading system, were examined, and had foot radiographs performed. Of 81 eligible patients, 59 (72%) were reviewed. Children in the two groups were not significantly different at the time of surgery for age, sex, and bilaterality. The patients were evaluated an average of 28 years (range, 25-30) after surgery in the posterior-release group and 16 years (range, 13-20) after surgery in the comprehensive-release group. Ponsetti scores were higher in the comprehensive-release group (mean, 86 vs. 81) but were not significantly different (p = 0.13). The comprehensive-release group required fewer procedures per patient compared with the posterior-release group (1.5 procedures vs. 2.0; p = 0.04). The ankle range of motion was similar in the two groups (p = 0.12), but the percentage of patients with subtalar stiffness was higher in the posterior-release group (50 vs. 18%; p = 0.01). Although the two groups were not statistically different based on the function-weighted Ponsetti scale, the comprehensive group had fewer operations, more complete correction of heel varus, and improved subtalar motion.