clubfoot: the treatment outcome using quantitative assessment of deformity

Introduction: The recent trend in management of congenital idiopathic clubfoot tends towards conservative treatment. This study reviews the outcomes of treatment in our practice using the quantitative clubfoot assessment of the deformity (QCAD). Methods: Thirty patients (38 cases of clubfoot) with congenital idiopathic clubfoot treated at Sarawak General Hospital were followed-up for a mean of 3.6 years. The quantitative assessment consists of limb anthropometric measurement and the Pirani deformity severity score. Results: There were 15 boys and 15 girls, with a mean age of 4.4 years (range, 13m - 8y). Most patients were of the Malay race (67%), followed by Chinese (23%) and others (10%). Eight patients suffered from bilateral congenital idiopathic clubfoot (33%), 12 were left unilateral (40%) and 10 were right unilateral (27%). Out of the total of 30 patients, 12 were treated conservatively with serial casting and 18 patients were treated surgically after resistance to serial casting at the age of nine months. At follow-up, there were significant differences between the surgical group (2.57 ± 1.45); (0.86 ± 0.36) and conservative group (0.7 ± 0.81); (0.34 ± 0.35) respectively (p < 0.05) regarding the mean difference in mid-leg circumference and foot length discrepancy in patients with unilateral clubfoot. There were no significant difference noted between groups with regards to results of the Pirani score, leg length discrepancy and mean difference of mid-foot circumference. Conclusion: There were significant differences in calf atrophy and foot length discrepancy when comparing surgically treated clubfoot patient compared to conservatively treated patients. Conservative treatment of clubfoot is the preferred method of treatment while surgical treatment may be necessary in more resistant cases.