Background: Although long-term follow-up studies have shown
favorable results, in terms of foot function, after treatment of idiopathic
clubfoot with serial manipulations and casts, we know of no long-term
follow-up studies of patients in whom clubfoot was treated with an extensive
surgical soft-tissue release.
Methods: Forty-five patients (seventy-three feet) in whom idiopathic
clubfoot was treated with either a posterior release and plantar fasciotomy
(eight patients) or an extensive combined posterior, medial, and lateral
release (thirty-seven patients) were followed for a mean of thirty years.
Patients were evaluated with detailed examination of the lower extremities, a
radiographic evaluation that included grading of osteoarthritis, and three
independent quality-of-life questionnaires, including the Short Form-36
Medical Outcomes Study.
Results: At the time of follow-up, the majority of patients in both
treatment groups had significant limitation of foot function, which was
consistent across the three independent quality-of-life questionnaires. No
significant difference between groups was noted with regard to the results of
the quality-of-life measures, the range of motion of the ankle or the position
of the heel, or the radiographic findings. Six patients who had been treated
with only one surgical procedure had better ranges of motion of the ankle and
subtalar joints (p < 0.004) than those who had had multiple surgical
Conclusions: Many patients with clubfoot treated with an extensive
soft-tissue release have poor long-term foot function. We found a correlation
between the extent of the soft-tissue release and the degree of functional
impairment. Repeated soft-tissue releases can result in a stiff, painful, and
arthritic foot and significantly impaired quality of life.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.