The Evaluation Of Long-term Outcome: The Treatment Of Congenital Clubfoot By Operation To Correct Deformity And Achieve Dynamic Muscle Balance

Clubfoot is a congenital foot deformity with an incidence of 1-3‰.The goals of treatment are to obtain a plantigrade,pain-free,flexible foot that does not require the use of orthotics. It is widely accepted that clubfoot treatment should start as early as possible. If the conservative method is failed and the deformatity is recurrence,surgical treatment can be used.various surgecial methods have been introduced depending an different aetiology and pathoanatomy.The muscle imbalance is an aetiological factor of the clubfoot.A large number of short-term reports of cases on different surgerical methods have been published,however,few reported the long-term result.Here is the long-term evalutation of the treatment of congenital clubfoot by an operation which corrects these deformities and achieves dynamic muscle balance.There are a lot of controversies over the etiology and pathogenesis of congenital clubfoot,many procedures for the treatment of CCF have been adopted so far,and the result are varied.A new protocol was designed by Prof.Yu-pu Lu in 1957 for managing clubfoot.The principle of the recommended treatment, according to Prof Lu's clinical and pathoanatomical studies in which the muscle imbalance was proved to exisit in the calf muscle,is one definitive operation with minimal trauma for correction of deformities and maintenance by achiving dynamic muscle balance.The preliminary results were satisfactory.From 1957 to 1993,970 patients(1373 feet)aged from 2 months to 12 years(1 years on average) with congential clubfoot were treated by the operations. Long-term results of 470 patients(569 feet)were evaluated by means of the criteria made by ourselves.The mean follow-up was 22 years 6 months after operations(range 16 to 52 years). Clinical and radiological assessment are used in this study to evaluate the long-term functional and radiographic result of patients.Using the scoring system described by ourselves,308 feet were considered exvellent,159 feet good,68 feet fair and 34 feet poor.Overall,467(82.07%) were rated as excellent or good.Feet with mild or moderate deformity had a better outcome than those with severe deformity. Good and excellent results were obtained in 82.07%,which was definitely correlated with the severity of the deformity and the age at operation(P<0.05).The good and excerlent long-term outcome was much lower than 91.83% in 1999 ,which was mainly related to the moderate and severe preoperative deformity .And the age of 6 months to 1 year old at operation has the best outcome in all the age teams.The establishment of dynamic muscle balance conveyed that early correction is an effective methods after the long-term follow-up,however,the good and excerlent long-term outcome is lower than the mid-term outcome.