Dr. Fernando Noriega's Blogspot

It’s never too late to repair the sequel of a congenital club foot

Posted: 30 Sep 2012 02:22 PM PDT

After vacation, we return to the institute eager to confront new challenges and to begin working once again on new projects.

Last Thursday, we had to repair the sequel of a congenital club foot. This young patient, let’s call her Macarena, has a rather tragic story. She was born with a deformed left foot; at first, she was treated conservatively with plaster casts, and subsequently with her first surgery at the age of three, which failed. At seven years old, she had a second surgery, performed by doctors who did not take the time to adequately study her case or to ask other specialists, in which they completely removed her talus bone. This surgery should actually only be applied in cases in which patients have a very rigid club foot, such as inarthrogryposis multiplex congenita (AMC). In Macarena’s case, it may have been possible to carry out an adequate reduction, freeing the side part of her foot.

If I’m not mistaken, contrary to what many doctors think, the side is where the real problem lies.

On top of all this mess, the patient received a surgery about a year ago at a hospital in the east coast of Spain, in which the only thing doctors could think to do was to fix the ankle in place by shortening it 3.7 centimeters and leaving it in the equine position via the insertion of an intramedullary nail. As this clearly didn’t work out well, they wanted to try to straighten the affected foot by shortening the metatarsal bones, and for the disymmetry they proposed shortening her healthy leg, which was longer. This truly shows the extent to which some doctors lack interest and expertise in treating these conditions.

So, in order to try to fix all of these problems, we first removed the intramedullary nail and the ankle arthrodesis. We removed a two-centimeter bone graft from the posterior iliac wing, correcting the disymmetry in the leg lengths, at the same time doing apartial resection of the navicular bone to take care of the club foot, which we then fixed with screws. As you can see in the pre-operation photos and video, the patient walked quite poorly at 30 years old.

In Macarena’s words, “Why are there so many doctors who, without sufficient knowledge and experience, decide to do this type of thing? It would be better if they asked specialists who could take care of these problems.” I answered: “In our country, not even 1% of professionals do that.”

Until next post.