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Talocalcaneal Interosseous Ligament Release May Benefit Patients with Severe Clubfoot

There has been some controversy in the treatment of clubfoot, mostly regarding surgery. Some surgeons prefer to do a technique that involves dividing a ligament in the foot called the talocalcaneal interosseous ligament, while others feel that it shouldn't be done. The procedure, called the TCIL, can result in an "over" correction of the clubfoot, some researchers say.

The researchers in this study wanted to compare the results of children who have surgery with, and without, TCIL. Forty-one boys and 5 girls (with 66 clubfeet total) were included in the study. They ranged in age from 2 to 24 months, with the average age being 9 months. During the surgery, half of the feet received the TCIL procedure and the other half did not. The researchers used before and after x-rays and magnetic resonance images (MRIs) to assess the changes in the feet. The feet were assigned a score depending on how they looked cosmetically, the range of motion, strength of the calf muscles, and findings on the x-rays and MRIs. The scores were then divided into 4 groups: above 75 was excellent and between 61 and 75 was good. Feet in these categories were considered satisfactory. If the score was between 46 and 60, the outcome was fair, and lower than 45 was considered poor. The feet in these two groups were considered to be unsatisfactory.

In group A, the patients who had the TCIL procedure, the outcome was excellent for 32 feet (96.9 percent); for group B, the patients who did not have the TCIL procedure, the outcome was excellent for 29 feet (87.9 percent). The fear that there would be an over-correction seemed unfounded when looking at the patients' MRIs 5 months after surgery, although the authors do say that the short duration of follow-up is a weakness of the study, and that other studies have shown over-correction in some patients.

The authors conclude that this procedure is advisable for patients with severe and very severe clubfeet.

References: Khamis H. El-Deeh et al. Is it Hazardous or Mandatory to Release the Talocalcaneal Interosseous Ligament in Clubfoot Surgery? In Journal of Pediatric Orthopaedics. July/August 2007. Vol. 27. No. 5. Pp. 517-521.

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