Introduction: Clubfoot is a common congenital deformity. Neglected clubfeet are not uncommon in the developing world where many children are brought late for initiation of treatment. The response to conservative treatment may not be adequate so as to achieve correction of deformity in all cases. Hence, some of these cases may require surgical treatment for correction of deformity.

International clubfoot study group (ICFSG) scoring system and the FRS system of Laaveg and Ponseti are validated instruments to evaluate the results of treatment in treated clubfeet. In this study we have used both the instruments to evaluate the results of treatment of operated clubfeet in neglected and relapsed clubfeet.

Material and Methods: 25 children, 16 with unilateral deformity and 9 with bilateral deformities comprising a total of 34 feet were evaluated for morphological, radiological and functional outcomes using the ICFSG scoring system and the FRS system of Laaveg and Ponseti. Children who had completed at least two years after the index surgical procedure were included in the study.

Results: 34 feet in 25 children were available for study after the inclusion and exclusion criteria had been met. The mean duration between the index procedure and evaluation was 2.95+_ 1.5 years (range 2-7.75 years).

The ICFSG score was at a mean of 6.029+_ 3.43 (range 2-14).

The FRS score of Laaveg and Ponseti was at a mean of 86.88+_9.47 for 25 male children and 87+_5.02 for 9 female children.

Discussion: A clubfoot is a congenital deformity with a reported incidence of 1-2/1000 live births. Weight bearing tends to aggravate the deformity making it stiffer and relatively resistant to conservative treatment. Many of these clubfeet that do not respond adequately to conservative line of management require surgery to achieve correction of the deformities.

In our study nearly half of the children (15 out of 34) scored excellent on the FRS score. 20 out of 34 feet scored excellent on the ICFSG scoring. A significant negative correlation was found between the two scores (p<0.002).

1. Bensahel H, Csukonyi Z, Desgrippes Y, Chaumien JP: Surgery in residual club-foot: one-stage medioposterior release "a la carte". J Pediatr Orthop. 1987, 7: 145-8
2. Penny JN. The neglected clubfoot. Techniques in orthopedics. 2005; 20(2): 153-166
3. Ponseti IV. Relapsing clubfoot: causes, prevention and treatment. Iowa orthop J. 2003; 12B: 269-271
4. Willis RB, Al-Hunaishel M, Guerra L, Kontio K. What proportions of patients need extensive surgery after failure of Ponseti technique for clubfoot? Clin Orthop Relat Res. 2009; 467: 1294-97
5. Park SS, Kim SW, Jung BS, Lee HS, Kim JS. Selective soft tissue release for recurrent deformity or residual deformity after conservative treatment of idiopathic clubfoot. J Bone Joint Surg (Br). 2009; 91: 1526-30
6. Sinha A, Mehtani A, Sud A, Vijay V, Kumar N, Prakash J. evaluation of Ponseti method in neglected clubfeet. Indian J orthop 2016:50: 529-35
7. Ayana B, Klungsoyr PJ. Good results after Ponseti treatment for neglected clubfeet in Ethiopia. Acta Orthop 2014 Dec; 85(6): 641-45
8. Bashi RH, Baghdadi T, Shirazi MR, Abdi R, Aslani H. Modified Ponseti method of treatment for correction of neglected clubfoot in older children and adoloscents- a preliminary report. J Pediatr Orthop B. 2016 Mar; 25(2): 99-103
9. Yamamoto H, Muneta T, Ishibashi T, Furuya K. posteromedial soft tissue release of the congenital clubfoot in children over five years of age. J Bone Joint Surg 1994; 76B: 555-8
10. Faldini C, Traina F, Martino AD, Nanni M, Acri F. can selective soft tissue release and cuboid osteotomy correct neglected clubfoot? Clin Orthop Relat Res 2013; 471: 2658-2665
11. Bensahel H, Kuo K, Duhaime M. Outcome evaluation of the treatment of clubfoot. The international language of clubfoort. J Pediatr Orthop 2003; 12B: 269-271
12. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital clubfoot. J Bone Joint Surg 1980; 62A: 23-31
13. Davids JR, Gibson TW, Pugh LI. Quantitative segmental analysis of weight bearing radiographs of the foot and ankle for children: normal alignment. J Pediatr Orthop 2005; 25(6): 769-76
14. Joseph B, Bhatia M, Nair SN. Talo- calcaneal relationship in clubfoot. J Pediatr Orthop 2001; 21(1): 60-64
15. Bourdeta C, Seringeb R, Adamsbaumc C, Gloriond C, Wicartd P. Flatfoot in children and adoloscents. Analysis of imaging findings and therapeutic implications. Orthopedics and traumatology: surgery and research 2013; 99: 80-87
16. Thometz JG, Simons GW. Deformity of the calcaneocuboid joint in patients who have talipes equinovarus. J Bone Joint Surg 1993; 75A(2): 190-95
17. Akini O, Akalin Y. Medium term results of single staged posteromedial release and triple arthrodesis in the treatment of neglected clubfeet in adults. Acta Orthop Traumatol turc 2015; 49(2): 175-82
18. Joseph B, Ajith K, Varghese RA. Evaluation of the hemi Cincinnati incision for posteromedial soft tissue release in clubfoot. J Pediatr Orthop 2000; 20(4): 524-28
19. Celebi L, Muratli HH, Akashin E, Yagmurlu MF, Bicimoglu A, Bensahel A. International clubfoot study group  evaluation of treated clubfoot: assessment of interobserver and intraobserver reliability. J Pediatr Orthop 2006; 15(1): 34-36
20. Katz MA, Davidson RS, Chan PSH, Sullivan RJ. Plain radiographic evaluation of pediatric foot and it’s deformities. Univ Pennsylvania Orthop J. 1997; 10: 30-39
21. Loza ME, Bishay SN, El-Barbary HM, Hanna A, Tarraf YN, Lofty AA. Double column osteotomy for correction of residual adduction deformity in idiopathic clubfoot. Ann Royal Coll Surg Eng 2010; 92: 673-79.

Vineet Aggarwal

IGMC, Shimla