Combination of midfoot derotational osteotomy and ankle arthrodesis against neglected clubfoot: a case report

Neglected congenital clubfoot in adults is difficult to manage. Multi-joint arthrodesis is often required but is invasive and associated with complications. We report an adult case treated with ankle arthrodesis and midfoot derotational osteotomy. A 59-year-old man with untreated idiopathic clubfoot since birth presented with severe hindfoot varus and rigid midfoot inversion, leading to wheelchair dependence. Imaging showed correctable hindfoot deformities but rigid midfoot inversion with talonavicular subluxation. Surgery consisted of Achilles tendon lengthening, ankle and subtalar arthrodesis with a retrograde intramedullary nail, and midfoot derotational osteotomy, resulting plantigrade. Bony union was confirmed at one year. At 3 years, plantigrade alignment remained without recurrence. Callosities resolved, and the patient regained pain-free walking. Clinical scores improved: Japanese Society for Surgery of the Foot ankle/hindfoot (4.0 to 66.0), Japanese Society for Surgery of the Foot midfoot (0.0 to 73.0), self-administered foot evaluation questionnaire (89.2 to 366.0). This is the first report of midfoot derotational osteotomy for neglected congenital clubfoot, offering a less invasive option for selected adults.