Anterior distal tibial hemi-epiphysiodesis for the treatment of fixed equinus in patients with recurrent clubfoot and sufficient growth potential

The management of recurrent clubfoot (RCF) in children of walking age is challenging, especially when secondary anatomic changes such as talar flattening are present. The purpose of this study was to report our experience with the use of anterior distal tibial hemi-epiphysiodesis (ADTH) in children with RCF and fixed equinus, to evaluate clinical and radiographic outcomes, and to compare our results with the available literature. This is a retrospective review of 14 patients (20 distal tibiae) treated with ADTH at our pediatric orthopedics referral institution between September 2021 and November 2022. The mean age at surgery was 10.1 years, and the mean follow-up was 23.7 months. Preoperative anterior-posterior (AP) and lateral radiographs and annual postoperative AP and lateral weight-bearing radiographs were reviewed to assess anterior distal tibial angle (ADTA), screw spread angle (SSA), and the correlation between SSA and ADTA variation. Clinical assessment was performed by measuring maximum ankle dorsiflexion and using the AOFAS scale. Complications were also recorded. Preoperative mean dorsiflexion was -7.1 ± 7.5 ° with negative values indicating plantarflexion. At final follow-up, mean dorsiflexion was 1.8 ± 8.2 °, with a statistically significant mean correction rate of 8.9 ± 11.14 °. Final ADTA and SSA showed 12.8 ± 8.4 ° ( P < 0.001) and 20.8 ± 16.9 ° ( P < 0.005) of improvement, respectively. There was also a good correlation ( r = 0.642) between the change in SSA and the change in ADTA. Plate and screws were removed in 1/20 cases (5%). ADTH in patients with RCF and fixed equinus reduces pain, minimizes equinus, and improves SSA and ADTA with limited complications.