Clubfoot posteromedial release is an open surgical procedure to release the tight ligaments, tendons, and joint capsules on the inner and back of the foot in a child with clubfoot that has not responded to Ponseti casting and bracing.
An incision is made around the inner and back of the ankle and foot (Cincinnati incision). The tight posterior and medial structures are systematically released — including the Achilles tendon, posterior ankle capsule, subtalar capsule, talonavicular capsule, and contracted ligaments. The foot is corrected into a normal position and held with K-wires. A cast is applied. The operation takes one and a half to two hours.
Posteromedial release is reserved for resistant or recurrent clubfeet that have not responded to the Ponseti method (casting, tenotomy, and bracing), or for complex clubfeet associated with other conditions.
The Ponseti method (serial casting, Achilles tenotomy, boots-and-bar bracing) is successful in over 95% of clubfeet and is the first-line treatment. Surgery is only considered when Ponseti treatment fails.
Thorough assessment by a paediatric orthopaedic surgeon. Documentation of previous treatment attempts.
Correction of the foot deformity allowing plantigrade (flat) weight-bearing. However, extensive surgical release is associated with more stiffness and higher rates of overcorrection than the Ponseti method.
The released joints often become stiff. This is the main long-term concern.
A large scar around the ankle.
The incision is extensive and in a difficult location.
The foot may be corrected into a flat or rocker-bottom position. Difficult to treat.
Damage to the blood supply of the talus.
Residual deformity requiring further surgery.
Particularly in complex or multiply-operated feet.
Posterior tibial neurovascular bundle at risk.
General anaesthesia.
Cast for six to eight weeks. K-wire removal at six weeks. Boots-and-bar bracing continues. Long-term follow-up throughout childhood. Custom orthotics may be needed.
Regular follow-up throughout childhood and adolescence.
The Ponseti method produces more flexible, functional feet with fewer long-term complications than extensive surgical release. Surgery is reserved for the small number of feet that fail Ponseti treatment.