From the Research
Flatfoot surgery in patients with overcorrected clubfeet should be approached with caution, prioritizing less invasive procedures and careful consideration of the specific deformity components to preserve remaining function and minimize complications, as supported by the most recent study 1.
Key Considerations
- The primary considerations for flatfoot surgery in overcorrected clubfeet include limited soft tissue elasticity, compromised vascularity, altered biomechanics, and potential neurovascular complications.
- A thorough clinical and radiographic evaluation is essential to assess the degree of overcorrection, remaining flexibility, and specific deformities present.
- Conservative management should be exhausted first, including custom orthoses, physical therapy, and activity modification.
- If surgery is deemed necessary, less invasive procedures should be prioritized when possible, such as medial column stabilization or limited arthrodesis rather than extensive reconstructive procedures.
Surgical Approach
- The surgical plan must address the specific components of the deformity while preserving remaining function.
- Tarsal osteotomies are successful methods for correcting flatfeet following extensive clubfoot surgery with rotational valgus and mild hinge valgus, as shown in the study by Oliver Eberhardt et al. 2.
- However, tarsal osteotomies are unable to successfully correct flatfeet that have a translatory valgus, and in such cases, double or triple arthrodesis is recommended.
Patient Counseling and Postoperative Management
- Patients must be counseled about realistic expectations, including the possibility of incomplete correction, prolonged recovery periods, and potential complications such as wound healing problems, nonunion, and persistent pain.
- Postoperative management requires vigilant monitoring for complications and may necessitate extended immobilization and rehabilitation protocols tailored to the patient's specific condition.
Recent Study Findings
- A recent study 1 found that surgical management of clubfoot overcorrection can lead to significant improvement in clinical and radiographic scores, with 81% of patients satisfied with the postoperative results.
- The study also highlighted the importance of tailoring the surgical approach to the specific type and symptomatology of the deformity, with medializing calcaneal osteotomy or subtalar arthrodesis performed for hindfoot valgus, and subtalar and/or midtarsal arthrodesis considered in cases of dorsal navicular subluxation.