[The effect of deep deltoid ligament release on dorsiflexion in congenital clubfoot treated with complete subtalar release]

Abstract

Objectives: We evaluated the effect of releasing the posterior half of the deep branches of the deltoid ligament on dorsiflexion capacity of the ankle in congenital clubfoot treated with complete subtalar release (CSTR).

Methods: Fifty-two feet of 35 patients with clubfeet were treated with CSTR. The patients were divided into two groups depending on the absence (group I) or presence (group II) of posterior deltoid ligament release. The groups consisted of 13 patients (21 feet) and 22 patients (31 feet), respectively. The original Cincinnati incision was used in all cases. In addition to the classical CSTR, posterior half of the deep branches of the deltoid ligament was released in group II. Both groups received the same postoperative care. The mean postoperative follow-up period was 55.5 months (range 36-77 months) in group I, and 24.7 months (range 10-37 months) in group II. The results were evaluated radiographically by measuring the talo-tibial and calcaneal inclination angles.

Results: It was observed that the calcaneus remained in equinus in both groups. Although posterior deltoid ligament release appreciably increased the dorsiflexion perioperatively, this did not represent a statistically significant functional improvement in group II.

Conclusion: Although the foot could be dorsiflexed and the talar dome observed posteriorly upon the release of the posterior half of the deep branches of the deltoid ligament, no beneficial clinical effect was observed because the tendo calcaneus could not be lengthened sufficiently.