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Ankle Range of Motion After Posterior Subtalar and Ankle Capsulotomy for Relapsed Equinus in Idiopathic Clubfoot

Jauregui, Julio J. MD; Zamani, Shirin MD; Abawi, Hummira H. DPM; Herzenberg, John E. MD, FRCSC

Journal of Pediatric Orthopaedics: April/May 2017 - Volume 37 - Issue 3 - p 199–203
doi: 10.1097/BPO.0000000000000611
Foot & Ankle

Introduction: Posterior capsulotomy can correct residual clubfoot deformity, but has been associated with ankle stiffness. The purpose of this study was to evaluate clinical ankle range of motion (ROM) following posterior capsulotomy immediately postsurgery and during long-term follow-up.

Methods: A retrospective clinical and radiographic review of 257 patients (398 feet) was performed to evaluate all patients who required a posterior capsulotomy as part of their clubfoot management. Twenty feet (16 patients) were identified with a mean age of 73.3±37.7 months and mean Pirani score of 5.2±0.8 points. Following capsulotomy, a long-leg cast was placed and maintained for a mean of 26 days (range, 21 to 35 d). At cast removal, parents were trained and instructed to immediately begin home physiotherapy. The capsulotomy cohort was age and sex matched to a cohort treated exclusively with the Ponseti method for comparison. Children in the comparison cohort had a mean Pirani score of 5.7±0.8 points.

Results: The mean dorsiflexion in the capsulotomy cohort significantly increased comparing the preoperative to the immediate postoperative ROM (from −6.5 to +9.7 degrees). No significant reduction in this gain was observed at latest follow-up (to +8.3 degrees). No significant difference in the plantar-flexion angle was found. Radiographically, a significant improvement in the lateral anterior tibial-calcaneal angle angles was found (P<0.05).

Conclusions: If utilizing our protocol for early mobilization, limited use of capsulotomy to treat relapsed clubfoot does not necessarily reduce ankle ROM. Our protocol of placing the feet in casts for a shorter duration of time and providing early physiotherapy helps maintain ankle ROM after a posterior capsulotomy.

Level of Evidence: Level III—therapeutic study.

*Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore

Department of Orthopaedic Surgery, University of Maryland Medical System, Baltimore, MD

Department of Orthopaedic Surgery, Atieh Hospital, Tehran, Iran

This study was performed at Sinai Hospital, Baltimore, MD.

This study and manuscript were performed without external funding.

J.E.H. received research support from Ellipse Technologies Inc. The following companies supported J.E.H. institution’s nonprofit organization, which provides financial assistance to the patients: Stryker, Orthocare Solutions, Medevations, Bay Scribe, Nations Healthcare, and Chesapeake Surgical. The following companies supported J.E.H. institution’s annual course for orthopaedic surgeons: Smith & Nephew, BrainLab, Orthofix, Synthes, Stryker, Wright Medical Technology, Biomet, and The MHE Coalition. The remaining authors declare no conflicts of interest.

Reprints: John E. Herzenberg, MD, FRCSC, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail:

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.