Abstract
Due to the increasing rate of relapses and the morbidity degree that this implies, we report our experience and results in the treatment of clubfoot in patients with myelomeningocele.
Between February 1996 and February 2001 12 patients with myelomeningocele (16 feet with clubfoot deformity and 4 bilateral cases) underwent surgical treatment. 5 were boys and 7 were girls. 3 relapsed cases were referred to our institution, 1 of them had a bilateral involvement. The average age at time of surgery was 27 months (range 7 months–5.3 years).
Levels of functional involvement were recorded according to Caneo (Argentina Chapter of Neuroorthopaedics) classification: Caneo 0: 2 patients, Caneo 1: 4 patients, Caneo 2: 8 patients, Caneo 3: 1 patient.
Relapses occurred in 3 cases; 2 with tendon lengthening technique and 1 tibialis posterior transfer to lateral peroneus brevis, split tibialis anterior tendon transfer. The complications were postoperative infection in 3 cases with wound dehiscence, tibia fracture after cast removal in 1 case and residual tibia intrarotation in 1 case. AFO were used in patients older than 2 years old with Caneo type 2 and 3 and RGO in patients with Caneo type 0 and 1.
The final results after solving all the complications were: 6 plantigrade feet, 1 intrarotated plantigrade foot and 1 relapsed inverse foot undergoing release of filum terminale with tethered spinal cord.
In conclusion, we consider the most effective technique the one that presents the lower rate of relapses and with efficient functional outcomes. We agree with Luciano Dias opinion that regional resection of all the tendinous elements is the best option to fulfill our goals.
We strongly advice a tendon lengthening or transfer in patients belonging to Caneo classification type 3.
