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Anterior Distal Tibial Epiphysiodesis for the Treatment of Recurrent Equinus Deformity After Surgical Treatment of Clubfeet

Al-Aubaidi, Zaid MD*; Lundgaard, Bjarne MD; Pedersen, Niels Wisbech MD

Journal of Pediatric Orthopaedics: September 2011 - Volume 31 - Issue 6 - p 716–720
doi: 10.1097/BPO.0b013e31822109b6

The treatment of clubfeet has changed constantly. Before the acceptance of the Ponseti serial casting, extensive surgical release was widely used. The treatment of relapse in these surgically treated clubfeet can be very challenging. Many methods have been used ranging from osteotomies to new posteromedial release, or correction using the Ilizarov fixator. Supramalleolar osteotomy was practiced for the treatment of residual equinus. The aim of this study is to evaluate the effect of anterior epiphysiodesis of the distal tibia on recurrent equinus deformity in patients with clubfeet treated surgically.

Methods We evaluated 25 children (31 feet) with recurrent equinus deformity after surgical treatment of clubfoot treated in our institution from 2003 through 2009. There were 16 boys and 9 girls, of whom 11 had recurrent equinus deformity on the left side, 8 on the right side, and 6 on the bilateral side. Three patients were treated with Richard staples and 22 were treated with 8-plates. Patients were examined clinically and radiologically, preoperatively. The mean dorsiflexion of the ankle was 2.5 degrees (−5 to 10 degrees) and the anterior distal tibial angle (ADTA) was 85 degrees. The patients were followed postoperatively and evaluated clinically and radiographically. The plates or staples were removed if the desired effect of around 15 degrees of dorsiflexion was achieved, or the ADTA shifted >15 degrees.

Results Mean follow-up was 22 months. Mean improval of dorsiflexion was 2 degrees, with a mean of dorsiflexion of 4.5 degrees, and mean radiological changes of ADTA were 13 degrees. We found no correlation between the radiographic changes and the clinically measured dorsiflexion.

Conclusions The use of anterior distal tibial epiphysiodesis does not seem to give a clinically significant improvement in dorsiflexion of the ankle despite a marked shift in the ADTA.

*Department of Orthopedics

Division of Pediatric Orthopaedic Surgery, Odense University Hospital

Odense University Hospital, Denmark

Source of support: None of the authors received financial support for this study.

The authors declare no conflict of interest.

Reprints: Zaid Al-Aubaidi, MD, Department of Orthopedics, Odense University Hospital, Soender Boulevard 29, DK-5000 Odense C, Denmark. e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.