Clubfoot: Conservative management and late surgery - Gavin Jennings 14/7/2001

Strapping(Robert-Jones technique)
Splinting(Dennis Browne bar)

Manipulation and Casting

-weekly for first six weeks of life in above knee cast at 90 ° then fortnightly until foot clinically and radiographically corrected.

Kite (see later)
Lovell/Hancock-Clin Orthop 70:79 1973)

Late Surgery

For residual or resistant clubfoot in older child. Generally involves osteotomy as well as soft tissue release.

Commonest residual deformities are forefoot adduction and suppination -95%
(Tarraf and Carroll- J Paed Orthop 12 1992) due to failure to release calcaneocuboid jointand plantar fascia.

General Guidelines (Campbell’s):

Deformity Treatment

Metatarsus adductus >5yr: metatarsal osteotomy

Hindfoot varus <3yr: modified Mackay procedure

3-10yr: Dwyer (isolated heel varus)

Lichtblau (long lateral column)

Dillwyn Evans (short medial column)

10-12yr: Triple arthrodesis(high pseudarthrosis rates in <12yr)

Equinus TA lengthening, post sub-talar and ankle osteotomy.

Lambrinudi Procedure