Saul Bernstein, MD
The pathogenesis of one of the classic orthopaedic malformations, the club foot, remains today unclear and the center of much controversy. Likewise, the treatment of this not uncommon condition (1 in 1,000 births in the U.S.) also remains subject to varying opinion and considerable controversy. Most pediatric orthopaedists do agree that the congenital club foot should be conservatively, nonoperatively treated. For many, this applies to even the severest presentations of this condition. Unfortunately, residual malformation remains evident in the majority of children treated conservatively in the first years of life. Failure rates reported in the literature over the past several decades vary considerably from 50% to as high as 90%.
The best time to perform a reconstructive operative procedure for club foot also remains controversial; however, most pediatric orthopaedists agree that surgical intervention should be delayed until the infant is 4 to 6 months of age. Debate continues as to what is the best surgical approach for such reconstruction. Today, there are approximately three primary surgical approaches for club foot; posterior release, posteromedial release, and circumferential. There are procedures which involve soft tissue release, lengthening and/or tendon transfers (of soft-tissue structures to remove a deforming force or to correct a muscular imbalance of the foot and/or ankle).
Pediatric orthopaedic specialist Dr. Saul Bernstein, of the Southern California Orthopedic Institute, routinely employs a unique, posteromedial and lateral approach for the reconstruction of club foot abnormalities. According to Dr. Bernstein, this approach provides optimal access to the medial back and lateral aspects of the foot to fixate the bones and secure the ligaments in the exact position required to completely correct any degree of deformity present. "The problem or limitation of other surgical approaches for club foot is that all you're doing is lengthening tendons, but you're not changing any of the excursion of the foot, so the tendons and the muscles will still remain weak, and this accounts partly for the atrophy that these children experience after serial casting." In addition, this type of approach minimizes the most serious of intraoperative concerns — overcorrection — which accounts for a significant percentage with other reported approaches.
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- Turco VJ Resistant congenital club foot: One-stage posteromedial release with internal fixation. A follow-up report of fifteen-year experience J Bone Joint Surg 46-B(3):1964;445-463
- Yngve DA, Gross RF, Sullivan JA Clubfoot release without wide subtalar release J Ped Orthop 10(4):473-476
- Total Run Time: 30:03 minutes
- Catalog Number: 1011
- VJO Publication Date: August, 1992