Outcome after Achilles tendon lengthening with a posterior capsulolysis according to Imhäuser in idiopathic congenital clubfoot.

BACKGROUND The Ponseti method has radically reduced the need for extensive surgical treatment in idiopathic clubfoot. At present there are no universally accepted criteria for the use of the various surgical techniques. MATERIAL AND METHODS 77 patients with idiopathic congenital clubfoot (111 affected feet) were treated according to Imhäuser. The operative release included z-shaped Achilles tendon lengthening and a posterior capsulolysis of the talocrural and talocalcaneal joint. In case of relapse in infancy and school age, a transfer of the tendon of the anterior tibial muscle (n=26) and a release of the alonavicular, navicular cuneiform I and cuneiform metatarsal I joints (n=15) were carried out. 49 patients with 70 clubfeet were followed up at a mean age of 9.8 years (+/- 7 years) and the length of follow-up averaged 8.6 years (+/- 6.2 years). RESULTS In 71.4% (50 feet) a "very good" or "good" correction of shape and in 64.2% (45 feet) "very good" or "good" function was achieved. A statistically significant correlation was found between delayed onset of walking and the risk of revision surgery due to a relapse of the deformity. CONCLUSIONS Important problems in the treatment of clubfoot according to Imhäuser in our study were residual partial forefoot adduction and restriction of mobility in the upper ankle joint. Our analysis of radiographs showed that despite unsatisfactory X-ray findings, clinical correction and mobility were good. Rigid congenital clubfeet, however, require peritalar releases.