|
Adult clubfeet are often easy to identify. Clubfoot
surgery really didn't become refined until the late 80's. Patients in their 20's and 30's that underwent Cincinnatti releases
are having far less problems then those in their 40's and 50's. Those teenagers that we are seeing are doing even better.
It is too early to see what the future will bring for those who have had the Ponsetti technique. Many will require additional
surgeries for undercorrection, but will they develop the severe arthritic changes that we have seen with the isolated Turco
(posteriomedial) releases performed in the 1950's-80's?
The following cases are examples of soldiers that were allowed
in the Army despite having clubfeet.
|
|
Cook in the Army who had posteriomedial releases as a child. Patient could barely walk as a result
of the arch and ankle pain.
|
Right foot is severely inverted.
|
Often clubfoot will develop ankle deformities as a result of the residual clubfoot deformity.
|
|
Residual metadductus deformity is still present. The talocalcaneal angle is still parallel.
|
Increased calcaneal inclination with abnormal talonavicular joint. Navicular is riding dorsal
to the talar head.
|
Another example of wedging of the navicular
|
|
Teenager who had an undercorrected deformity. Staple was utilized to fixate the calcaneus after
a dwyer calcaneal osteotomy was performed. Note the subtalar DJD and ankle compensation as a result of the residual equinus.
|
Older patient who developed severe subtalar and ankle DJD.
|
This patient developed an equinus that majority of ankle dorsiflexion was occurring at the talonavicular
joint instead of the ankle.
|
|
One of the many success stories. Soldier had Cincinnatti release as a child. Was able to join
the Army, complete both Ranger and Special Forces despite have clubfoot surgery. His foot and ankle are not perfect, but
he functions at a very high level despite his deformy.
|
Other then his scars and knowing what type of surgery he had as a child, you could hardly tell
he had a clubfoot.
|
More typical of the adult clubfeet most surgeons will see - residual metadductus with parallel
talocalaneal angle
|