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.
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
Pitfalls & Challenges