Arthrogrypotic Club Foot

Abstract

Background: Arthrogryposis Multiplex congenita is a rare disorder, characterized by multiple joint deformities i.e. multiple congenital contractures, with shapelessly cylindrical limbs and absent skin creases.
Club foot can be the only obvious deformity of this widespread disorder.
Objective: To assess the most frequent recurrent deformity after extensive soft-tissue release operations for arthrogrypotic club foot and its appropriate treatment regarding combined tendon transfer and bony operations.
Methods: A retrospective study of 14 patients with arthrogrypotic club foot (28 feet), had been operated on by multiple soft tissue and bony operations and followed in a period between January (1993) till February (1999).
Both clinical assessment including goniometer use to measure the recurrent deformity, and radiological assessment, was used in this study.
Results: In this series, 4 patients (7 feet) had recurrent deformity, 3 patients
(5 feet) out of these 4 had recurrent forefoot adduction, 2 of them had bilateral affection. The 4th patient had bilateral recurrent varus heel.
Conclusion: The main problem in arthrogrypotic club foot is the liability for recurrence. The most frequent recurrent deformity was forefoot adduction. Combined tendon transfer and bony operations can correct the deformity once performed at the same cession forefoot adduction. All required 2nd operation, in the 1st 3 patient combined Evan’s (calcaneocuboid wedge-excision) and tibialis anterior transfer operations were performed. Talectomy was performed on one foot in the 4th patient, combined with capsulectomy of the calcaneocuboid joint, while triple arthrodesis don on the other foot.
Key words: arthrogrypotic club foot, recurrent forefoot adduction, tibialis ant. Transfer