Obstinate Club Foot with Triple Plus Dislocations

Abstract

ABSTRACT Resistant/rigid club foot, a common orthopedic problem, still remains an unsolved problem, especially, when we come across deformities in older children, adolescents or adults, after multiple surgeries and sometimes unique cases, like this one. This case had unique pathoanatomy, due to congenital factors, increasing age and persisting with vengeance in spite of two earlier surgeries. Before planning another surgery, it was imperative to diagnose the actual cause, i.e. the unique pathoanatomy. Various other surgical options were not expected to give the desired result due to this unique pathoanatomy. The author has been in club foot research since long and the concept of this research has been based on pathoanatomy and its total correction. During this research process, there have been numerous need based modifications from time to time, based on applied interpretations of pathoanatomy, to make it effective in all resistant club feet, at any age, including adolescents and adult, which have been used in a large series with adequate follow-up in the past 25 to 30 years, with gratifying results. The landmark modifications have been: giving a generic name obstinate club foot given to every imaginable rigid club foot of any age, a substitute for multiple names found in literature; surgical technique named as dolarz technique incorporating Z-plasties in dorsolateral rotation skin flap (DOLAR); a modification of the earlier technique already reported in the literature and not likely to succeed. Besides the skin flap, the modified extended deeper extensive soft tissue and osseous release was named as subtotal subtalar release (SSR). Treatment of the present case was by Dolarz technique, with some newer modifications. Each step was more extensive focusing on triple plus dislocations, including an innovative sliding osteotomy of cuboid for complete correction. Awareness for diagnosis and good preoperative planning was essential for gratifying result. How to cite this article Mittal RL. Obstinate Club Foot with Triple Plus Dislocations. J Foot Ankle Surg (Asia-Pacific) 2014;1(2):72-77.