Growth Disturbance of the Distal Tibia in Patients With Idiopathic Clubfeet: Ankle Valgus and Anteflexion of the Distal Tibia

BACKGROUND: The aim of this study was to evaluate the incidence of deformities of the distal tibia in patients with idiopathic clubfeet who had undergone surgical intervention with a circumferential release through a Cincinnati incision in early infancy.

METHODS: A retrospective follow-up evaluation of children with idiopathic clubfoot was conducted. We reviewed children who had undergone surgical treatment by a circumferential release in our department after unsuccessful casting, and who were at least 10 years of age. Main focus was the measurement of anteroposterior and lateral view radiographs for distal tibia deformities. Of 65 patients (93 feet) who had surgery for idiopathic clubfoot from 1998 to 2002, radiographic data of 35 patients (52 feet) were analyzed.

RESULTS: An anteflexion deformity was present in 25 of 52 feet (48.1%) and a valgus deformity in 29 of 52 feet (55.8%). A flat-top talus was evident to some degree in all cases. An abnormal lateral talocalcaneal angle was evident in 42.3%.

CONCLUSIONS: These results show the importance of conducting follow-up evaluations on patients with idiopathic clubfoot for secondary deformities of the distal tibia. This is the first study, to our knowledge, highlighting the high incidence of distal tibial deformities after surgery for idiopathic clubfoot. It is unclear at this time whether this is also true for clubfeet after conservative treatment. However, patients with clubfeet should have radiographs of the ankle joint between the age of 10 and 12 years to be able to treat possible deformities through guided growth.

LEVEL OF EVIDENCE: Level III.