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Scientific Articles   |    
Surgical Treatment of Overcorrected Clubfoot Deformity
Markus Knupp, MD1; Alexej Barg, MD1; Lilianna Bolliger, MSc1; Ashley L. Kapron, BS2; Beat Hintermann, MD1
1 Department of Orthopaedic Surgery, Kantonsspital Liestal, CH-4410 Liestal, Switzerland. E-mail address for M. Knupp: markus.knupp@ksli.ch. E-mail address for A. Barg: alexejbarg@mail.ru. E-mail address for L. Bolliger: lilianna.bolliger@ksli.ch. E-mail address for B. Hintermann: beat.hintermann@ksli.ch
2 Department of Orthopaedic Surgery, Harold K. Dunn Orthopaedic Research Laboratory, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address: ashley.kapron@utah.edu
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Based on an original article: J Bone Joint Surg Am. 2012 Aug 1;94(15):e110.



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Feb 27;3(1):e4 1-9. doi: 10.2106/JBJS.ST.L.00020
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Extract

Overview
Introduction

In our experience, a supramalleolar osteotomy with or without calcaneal osteotomy and midfoot osteotomy has been an effective treatment for sequelae resulting from overcorrected clubfoot deformity.

Step 1: Preoperative Assessment and Planning

Determine the treatment using the decisional algorithm in Figure 3.

Step 2: Patient Positioning

Use spinal or general anesthesia, administer intravenous antibiotics, position the patient supine, apply a tourniquet.

Step 3: Medial Approach to the Distal Part of the Tibia

Use a medial approach to expose the distal part of the tibia.

Step 4: Supramalleolar Osteotomy

Remove the bone wedge, close the osteotomy, and use rigid plate fixation to secure the correction.

Step 5: Additional Procedures (If Necessary)

If necessary, perform fibular osteotomy, calcaneal osteotomy, and/or plantar flexion osteotomy of the first cuneiform.

Step 6: Closure of All Incisions and Postoperative Care

A short leg splint is worn for two days, followed by partial weight-bearing with the ankle protected in a splint at night and a walking boot during the day for eight weeks.

Results

Between 2002 and 2009, fourteen adult patients (mean age, thirty-seven years; range, nineteen to sixty-six years) who presented with a symptomatic overcorrected clubfoot deformity were treated with a supramalleolar osteotomy.

What to Watch For

Indications

Contraindications

Pitfalls & Challenges

Figures in this Article

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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