Surgical Management of Clubfoot by Modified Carroll's Technique

Mahesh Babu, B (2006) Surgical Management of Clubfoot by Modified Carroll's Technique. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: The clubfoot is the most common congenital orthopaedic condition requiring intensive treatment. As the clubfoot most likely represents a congenital dysplasia, treatment of idiopathic true clubfoot can never produce a normal extremity. AIM: The aim of management of CTEV is to obtain a painfree, plantigrade, supple and functional foot which is cosmetically acceptable and normal footwear can be worn. Surgical management of resistant or persistent clubfoot after conservative management needs more judgement and skill than any other orthopaedic condition amenable to surgical correction. There are innumerable soft tissue procedures described for primary correction of clubfoot. The aim of this study is to evaluate the results of primary correction of clubfoot by modified Carroll’s double incision technique. MATERIALS AND METHODS: At our institution, we selected 20 severe resistant clubfeet of 17 children for this prospective study. The age group varied from a minimum of 5 months to a maximum of 18 months and average age was 8 months. The duration of the study was from November 2003 to January 2006. The maximum follow up was 14 months. Average follow up was 10 months. Of the 17 children, right side was involved in 5 cases and left side was involved in 9 cases; 3 cases were bilateral. Of 20 clubfeet, 8 were of grade III severity and 12 were of grade IV severity. All the club feet were initially treated by serial long leg plaster of paris cast using kite’s method10 upto the age of 4 months or 6 to 7 cast. Plasters were changed every 2 weeks. After it was determined that the deformity could not be corrected with 4 months of serial casting, the feet was considered resistant and surgery was contemplated. RESULTS: All the wound healed primarily without infection and breakdown. Residual deformities were present in 3 cases. One child had residual forefoot adduction and supination. Two other children had residual forefoot adduction deformity. Residual deformities in all the three children were mouldable and we are treating these children with corrective cast itself. Good results were achieved in 17 of the 20 clubfeet (85%). We evaluated our results using Dimeglio5 method of grading severity of clubfoot. Each major component of clubfoot (ankle equinus, heel varus, derotation of calcaneopedal block and forefoot adductus) are graded clinically from 4 to 1 (most severe to mild). Additional points are added for deep posterior and medial creases, cavus and poor muscle function. Total score is stratified into four groups of severity (Benign to very severe, Grade I to IV). CONCLUSION: Carroll’s dual incision technique offers goods exposure to the posterolateral, subtalar and medial structures without wound healing problems. This technique gives supple and cosmetic foot. With our limited experience in this technique, it is definitely a procedure of choice in the surgical management of severe resistant club foot.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Surgical Management ; Clubfoot ; Modified Carroll's Technique.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 15:08
Last Modified: 17 Sep 2017 02:16

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