When Does Clubfoot Require Surgery and What Types of Surgeries Are Performed?

Surgical intervention for clubfoot is generally considered when non-surgical methods, particularly the Ponseti technique, are unsuccessful. Surgery may be necessary in the following situations:

Failure of conservative treatment: When non-surgical approaches do not achieve the desired correction.
Recurrence of deformity: When the deformity returns after initial correction.
Complex or atypical cases: Cases with severe deformities or those associated with other medical conditions.

Types of Surgeries for Clubfoot

Soft Tissue Procedures

Percutaneous Achilles Tenotomy:
A minimally invasive procedure often performed as part of the Ponseti method to lengthen the Achilles tendon through a small incision.
Tibialis Anterior Tendon Transfer:
Performed in older children to maintain correction and reduce the risk of recurrence by redistributing muscle pull.
Soft Tissue Releases:
These involve lengthening tight tendons and ligaments around the foot joints to improve alignment.

Bony Procedures

Osteotomies:
Involves cutting and realigning bones to correct deformities.
Double Column Osteotomy:
A specialized procedure used in revision surgeries to address residual fixed forefoot adduction deformities.
Arthrodesis:
Fusion of two or more bones to stabilize and align the foot, typically reserved for severe or complex cases.

Extensive Reconstructive Surgery

In rare and severe cases, extensive reconstructive surgery may be required.
This involves releasing multiple soft tissue structures and is usually reserved for deformities that are resistant to less invasive methods or associated with syndromes.

Current Trends in Clubfoot Treatment

Due to the success of the Ponseti method, surgical intervention is now less common. Studies show that only about 30-50% of clubfoot patients require surgery, and most of these involve less extensive procedures like tenotomy or soft tissue releases. Early diagnosis and adherence to non-surgical treatment protocols significantly reduce the need for major surgical interventions.