Comparison of modified posteromedial release and complete subtalar release in resistant congenital clubfoot: a randomized controlled trial

Abstract

Objective: To compare the surgical results of modified posteromedial release with modified complete subtalar release in resistant congenital clubfoot in a randomized controlled trial

Material and method: Eighty six children with 128 clubfeet, at an average of 5.9 months old (3-12 months) were operated on between 1996 and 2006 by a single surgeon. They were randomized into two groups. Group A, the modified posteromedial release was performed on 47 children with 69 clubfeet from 26 boys and 21 girls. Group B, the modified complete subtalar release was performed on 39 children with 59 clubfeet from 22 boys and 17 girls. Both groups received the same postoperative protocols. The mean follow up time was 15.1 months in group A (3-90 months) and 23.7 months in group B (3-120 months).

Results: There were no statistically significant differences of both groups between age, sex, side, bilaterality, and Dimeglio pre-operative evaluation. Most of the children ended up with satisfactory appearance of feet without major complications, neurovascular injuries, talonavicular dislocation, or avascular necrosis of the talus. Mild forefeet adduction was found in 10 feet in group A and in 5 feet in group B but allfeet were flexible and reducible to normal alignment of the feet. Two feet in group A and one foot in group B were re-operated by soft tissue release without bone surgery and had fair results. Four feet in group A and two feet in group B got soft tissue infection and resolved in a few weeks by dressing and antibiotics. The postoperative mean Ponseti score was 89.6 (75-100) points in group A and 88.2 (70-98) points in group B without statistically significant difference (p = 0.25). The Turco postoperative evaluation of both groups was not statistically significantly different (p = 0.17). The good and excellent results from Ponseti score was 85.5% in group A and 89.9% in group B. The correlation coefficient (r) between Ponseti and Turco evaluation was 0.81.

Conclusion: The clinical and statistical significant difference were not found in the surgical results of modified posteromedial release and modified complete subtalar release in resistant clubfeet.