Subastragalar Triarticular Arthrodesis for Congenital Club Foot in Children Aged 2 1/2-15 Years

Intractahle cluh foot in older children, which seeins uncorrcctnhle by conservative trcatmcnt and operations to the soft tissues is a troublesome problem.Whcthcr early opcration by triarticular arthrodcsis in these patients can achievc a lasting functional and trouble-free foot is a matter for discussion. C O hl P 0 S I 'I' I 0 N 0 F hl A T E H 1 A I,From 1948 to 1960 863 cases of cringenital cluh foot were treatcd a t t h e Karolinska Institute's orthopaedic clinic.Ahout half were primary, untreated, newborn cases, a n d t h e rest were previously treated elsewhere, and had received quite inadequate treatment.The material is t h u s loaded with an unfavourahle selection.Of these 863 patients, 14 patients with 55 cluh feet were treated hy triarticular suhtalar arthrodesis from the ages of 2 % to 15 years because a satisfactory position of t h e feet could not he ohtained hy conservative treatment (manipulation, plaster, night splints and braces) together with other different operations.Of the fcct treatcd h y suhtalar arthrodesis, 34 had never been fully corrected, and 21 h a d h a d recurrences.A l l had a cavus-adductus-cquinovarus deformity except one, w h o had a n over-corrected plano-valgus foot.14 patients had also other congenital deformities, among ihcm four congenital dislocations of t h e hip, five congenital h a n d contractures and deformities, two meningtrceles w i t h hydrtrcephaly, one cleft palate, and two others with multiple deformities.Moreover, apart from club foot and these ahnormitics, a numher also suffered from mental retardation.Hereditarily afflicted cases are strongly under-represented i n t h e operated material.Only five patients showed any heredity, and only i n one case could more cases of cluh foot be found among relatives.Classification h y sex reveals 24 huys a n d 20 girls, Before t h e arthrodesis 34 ( 7 7 per cent) were ohliged t o use orthopaedic shoes or braces.For distribution with regard t o age, see Tahle 1.I n t h e ahsence of a careful preoperative classification of the feet, t h e operated patients m a y b e reckoned to be among the so-called severe club feet.