To The Editor:In the paper "Long-Term Follow-up of Patient with Clubfeet Treated
with Extensive Soft-Tissue Release"
(2006;88:986-96), Dobbs et al.
reviewed the long-term outcomes of an aggressive surgical release that was
undertaken following failed conservative management. Neonatal and/or
preoperative clubfoot classification is important in order to identify those
feet that may have a poor prognosis with conservative treatment1.
Non-iatrogenic constitutional stiffness of the foot may worsen, with
functional deterioration, in the long term, independent of the treatment
modality employed. The poor results that Dobbs et al. reported may have been
due in part to the conservative approach that was utilized. The Kite
method2 was criticized by Ponseti3 as resulting in a
spurious correction (Kite's error). Following the surgical releases in the
study by Dobbs et al., the patients were treated for an extensive period of
time with plaster casts (four months) and orthotics (two to four years). This
long-term immobilization has the potential to stiffen the joint secondary to
the fibrosis that occurs following surgery.