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Satisfactory Patient-based Outcomes After Surgical Treatment for Idiopathic Clubfoot: Includes Surgeon’s Individualized Technique

Mahan, Susan T. MD, MPH*,†; Spencer, Samantha A. MD*,†; Kasser, James R. MD*,†

Journal of Pediatric Orthopaedics: September 2014 - Volume 34 - Issue 6 - p 631–638
doi: 10.1097/BPO.0000000000000197

Introduction: Treatment of idiopathic clubfoot has shifted towards Ponseti technique, but previously surgical management was standard. Outcomes of surgery have varied, with many authors reporting discouraging results. Our purpose was to evaluate a single surgeon’s series of children with idiopathic clubfoot treated with a la carte posteromedial and lateral releases using the Pediatric Outcomes Data Collection Instrument (PODCI) with a minimum of 2-year follow-up.

Methods: A total of 148 patients with idiopathic clubfoot treated surgically by a single surgeon over 15 years were identified, and mailed PODCI questionnaires. Fifty percent of the patients were located and responded, resulting in 74 complete questionnaires. Median age at surgery was 10 months (range, 5.3 to 84.7 mo), male sex 53/74 (71.6%), bilateral surgery 31/74 (41.9%), and average follow-up of 9.7 years. PODCI responses were compared with previously published normal healthy controls using t test for each separate category. Included in the methods is the individual surgeon’s operative technique.

Results: In PODCIs where a parent reports for their child or adolescent, there was no difference between our data and the healthy controls in any of the 5 categories. In PODCI where an adolescent self-reports, there was no difference in 4 of 5 categories; significant difference was only found between our data (mean=95.2; SD=7.427) and normal controls (mean=86.3; SD=12.5) in Happiness Scale (P=0.0031).

Discussion: In this group of idiopathic clubfoot patients, treated with judicious posteromedial release by a single surgeon, primarily when surgery was treatment of choice for clubfoot, patient-based outcomes are not different from their normal healthy peers through childhood and adolescence. While Ponseti treatment has since become the treatment of choice for clubfoot, surgical treatment, in some hands, has led to satisfactory results.

Level of Evidence: Level III.

*Department of Orthopaedics, Boston Children’s Hospital

Department of Orthopaedics, Harvard Medical School, Boston, MA

The authors declare no conflicts of interest.

Reprints: Susan T. Mahan, MD, MPH, Department of Orthopaedics, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115. E-mail:

© 2014 by Lippincott Williams & Wilkins