Clubfoot deformity in congenital constriction band syndrome: manifestations and treatment.

Clubfoot deformity associated with congenital constriction band syndrome (CCBS) has different characteristics than classic idiopathic clubfoot, and is more difficult to treat. We describe the manifestations, treatment, and outcomes of nine patients treated for 11 CCBS-associated clubfoot deformities between 1980 and 1993. All but one of these children had an abnormal gestational or neonatal history. From an assessment of the correctability of the deformity and the associated secondary changes, the clubfoot severities were all classified as grade B (intermediate). The constriction bands in eight clubfeet were classified as type 0 (5 feet), II (2), or III (1), according to the location and depth of the band. Band types in three feet were unclassified because the band release was performed at other hospitals. We released the bands before correcting the clubfeet in the two patients with type II bands. The five patients with type 0 bands received casting first but with poor response. All clubfeet were corrected surgically; the procedures were posteromedial release in 10 feet, split tibialis anterior tendon transfer in five, and lengthening of the Achilles tendon in three. At an average follow-up of 3.8 years, seven of the 11 clubfeet were classified as having good results and four as fair. Among the six clubfeet with constriction bands on the ipsilateral leg, five were classified as having good results and one as fair. Two of the five clubfeet without constriction bands on the ipsilateral leg had good results and three had fair results. The presence of a band did not influence the final outcome of the clubfoot deformity (p > 0.05). In the five patients with forefoot varus deformity due to peroneal weakness, tibialis anterior tendon transfer successfully corrected the deformity. All the clubfeet treated in this series were plantigrade after treatment and had satisfactory results.