Modified Turco procedure for treatment of idiopathic clubfoot.

UNLABELLED: Since 1980 we have used a modified Turco procedure for treating congenital clubfoot. The modifications include: (1) lateral position with the unaffected side on top; (2) Cincinnati-type transverse heel crease incision from the base of the first metatarsal around the ankle up to the lateral border of the tendoachilles; (3) complete excision of the abductor hallucis muscle; (4) complete tibialis posterior tendon tenotomy in the sheath; (5) no lengthening of long toe flexors; (6) no K wires for maintaining the correction; and (7) special splints instead of Denis Browne splints. Thirty-three feet in 18 patients were followed up prospectively at a mean of 13.8 years (range, 10-16 years). There were no wound complications. The mean Laaveg and Ponseti score was 87.2 (range, 49-98). Twenty-seven (82%) of 33 feet had good to excellent results. There were seven feet (21%) with recurrent deformities, which included two feet (6%) with recurrence of all deformities, two feet (6%) with forefoot adduction, one foot each (3%) with equinus and heel varus, and one (3%) with cavus. Ninety-four percent of patients were very satisfied or satisfied with the results. We think this modified approach has helped us to reduce the recurrence of forefoot adduction deformity and wound complications.

LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series-no, or historical control group). See Guidelines for Authors for a complete description of levels of evidence.