Minimally invasive management of relapsed clubfoot: Percutaneous tendo-Achilles and plantar fascia releases combined with soft tissue distraction using the Ilizarov method.

BackgroundRelapsed congenital talipes equinovarus (clubfoot) in children who have undergone previous surgical intervention presents a significant treatment challenge due to soft tissue scarring, joint stiffness, and complex multiplanar deformities. The Ilizarov method offers a minimally invasive approach that allows gradual correction while preserving soft tissue integrity.MethodsThis retrospective case series evaluated 26 relapsed clubfeet in 21 patients treated between January 2020 and June 2024. All patients had previously undergone operative treatment and presented with rigid or partially correctable deformities. Management consisted of minimally invasive soft tissue procedures, including percutaneous tendo-Achilles lengthening and selective plantar fascia release, followed by gradual correction using an Ilizarov frame. Clinical deformities (equinus, hindfoot varus, forefoot adduction, and supination) were measured pre- and postoperatively. The mean follow-up period was 2.4 years.ResultsAll feet achieved a plantigrade position at the time of frame removal. The mean duration of treatment in the Ilizarov frame was 11.1 weeks. There was significant improvement in all deformity components (p < 0.001), with equinus improving from a mean of 25° to 1°, varus from 28° to 4°, adduction from 31° to 4°, and supination from 23° to 2°. Full or near-complete correction (≤5° residual in all components) was achieved in most feet, and functional outcomes were favourable, with restoration of near-normal gait and ability to wear standard footwear. Complications were minor; superficial pin-site infection occurred in 10 of 26 feet (38.5%), all managed conservatively. Recurrence was infrequent and did not significantly affect functional outcomes.ConclusionThe Ilizarov method combined with minimally invasive soft tissue release is a safe and effective technique for the management of relapsed congenital clubfoot. It allows gradual correction of complex deformities with preservation of joint mobility, low complication rates, and satisfactory functional outcomes. This approach represents a valuable alternative to repeated open surgical procedures, particularly in younger children.