Radiographic Prognostic Factors for Selective Soft Tissue Release After Ponseti Failure in Young Pediatric Clubfoot Patients.

BACKGROUND: Selective soft tissue release (SSTR), which includes a combination of abductor hallucis, tibialis posterior, and Achilles lengthening, has been used in patients with recurrent clubfoot deformity after Ponseti treatment. The aim of this study was to investigate the prognostic factors for recurrence of clubfoot deformity after SSTR.

METHODS: Consecutive patients with idiopathic clubfoot and residual or recurrent deformity after Ponseti treatment underwent SSTR between 2005 and 2013. The clinical and radiologic characteristics before and after SSTR were analyzed. The ability of radiologic factors to predict recurrence of clubfoot deformity was assessed using multivariate analysis. Rigid deformities of forefoot adduction, and hindfoot varus, and equinus were examined separately. Forty-three patients with 64 clubfeet were included.

RESULTS: Postoperative improvement in the talo-first metatarsal angle on the anteroposterior view, the talocalcaneal angle on the lateral view, and the tibiocalcaneal angle on the lateral view independently predicted recurrence after SSTR. Additionally, the preoperative talocalcaneal angles on the anteroposterior and lateral views were also significant predictors, but these angles did not significantly improve after SSTR.

CONCLUSIONS: SSTR seems to be an effective surgical modality only in milder deformities. Among patients with poor talocalcaneal angles, a high percentage required further surgery. The present results may be useful for the choice of SSTR or more extensive surgery.

LEVEL OF EVIDENCE: Level III, retrospective case-control study.