Essential Surgical Techniques
Surgical Treatment of Overcorrected Clubfoot Deformity
Markus Knupp, MD; Alexej Barg, MD; Lilianna Bolliger, MSc; Ashley L. Kapron, BS; Beat Hintermann, MD

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 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

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.

The prevalence of ankle valgus in patients treated for clubfoot deformity has been reported to be up to 67%1. Clinically, patients with overcorrected clubfoot deformity often present with calcaneofibular impingement, anterior ankle impingement due to a flat-top talus, and flatfoot deformity. Options for surgical treatment of symptomatic overcorrected clubfoot deformity include epiphysiodesis1,2 in skeletally immature patients and hindfoot fusions3, …


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