Introduction: Congenital talipes equinovarus (CTEV), or clubfoot, is a common neonatal orthopedic malformation characterized by a complex three-dimensional deformity combining equinus, varus, and adduction. Despite the efficacy of the Ponseti method as the standard of care, certain resistant, neglected, or late-diagnosed forms require surgical intervention via posteromedial release (PMR).
General Objective: To describe the epidemiological, clinical, therapeutic, and outcomes profile of patients who underwent posteromedial release for congenital talipes equinovarus in a pediatric orthopedics and traumatology department.
Specific Objectives: To determine the sociodemographic and clinical characteristics of patients operated on for CTEV.
• To describe the modalities of conservative (orthopedic) and surgical management.
• To evaluate functional outcomes following posteromedial release.
• To identify the primary postoperative complications and causes of treatment failure.
Materials and Methods: This was a retrospective descriptive study conducted at the Pediatric Orthopedics and Traumatology Department of the Abderrahim Harouchi Mother-Child Hospital in Casablanca between January 2018 and December 2021. The study included 48 patients aged 0.9 months to 16 years who underwent surgery for CTEV. The analyzed variables encompassed sociodemographic data, clubfoot type, associated anomalies, therapeutic modalities, and postoperative outcomes. Statistical analysis was performed using Jamovi software (version 2.3.28).
Results: Among the 48 included patients, 65% were male, yielding a sex ratio of 2:1. The mean age was $5.5 \pm 4.23$ years. Idiopathic forms accounted for 60.4% of cases, of which 39.6% were bilateral. The primary associated anomalies were developmental dysplasia/congenital dislocation of the hip (14.3%), arthrogryposis (10.7%), and cerebral palsy (10.7%). The majority of patients (90%) demonstrated good treatment adherence. PMR was primarily performed following the failure of conservative treatment. The main observed complications were recurrence, skin necrosis, and postoperative infections. Surgery performed after the walking age constituted the primary cause of therapeutic failure.
Conclusion: Early management of CTEV using the Ponseti method effectively reduces the need for surgical intervention. However, posteromedial release remains a critical option for resistant or neglected cases. A well-indicated surgical intervention, combined with tailored postoperative immobilization and physical therapy, improves functional outcomes and minimizes the risk of complications.