Surgical management of idiopathic congenital talipes equinovarus by Carroll twin incision

K. Vijaya Bhaskar Reddy, Narsimha Lavudi


Background: Surgery for congenital idiopathic clubfoot has a number of complications in the postoperative period such as delayed wound healing, gaping, infection, and recurrence of the deformity. The aim of this study is to evaluate the results of primary correction of clubfoot by modified Carroll’s double incision technique.

Methods: It is a prospective interventional for a period of 2 years 5 months. 56 foot of which 21 pts have bilateral deformity and 14 pts with unilateral deformity. Patients of 3 months to 2 years age with idiopathic clubfoot, who did not respond to initial Ponseti casting; and were planned for Carroll double incision technique of surgery were included in this study.

Results: In total 56 foot of which male are 23 and female children are 12 in number with male: female ratio of 1.9:1, showing male predominance, 21 pts have bilateral deformity and 14 pts with unilateral deformities. The mean change in radiographic parameters achieved by correction is as postoperative mean talocalcaneal index achieved was 42.60 (Normal range >40°). The postoperative mean anteroposterior talo-calcaneal angle was 26.20 (Normal range 300 to 550). The Postoperative mean lateral talo-calcaneal angle was 24.40 (normal 200 to 400). Final outcome is 81% is good, 14 fair and 5% has poor outcome.

Conclusion: Exposure and release by Carroll’s twin incision is good, no tension in sutures, especially medical incision at the time of wound closure.


Club foot, Carroll’s double incision technique, Talo-calcaneal angle

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Lochmiller C, Johnston D, Scott A, Risman M, Hecht JT. Genetic epidemiology study of idiopathic talipes equinovarus. Am J Med Genet. 1998;79(2):90-6.

Byron-Scott R, Sharpe P, Hasler C, Cundy P, Hirte C, Chan A et al. A South Australian population-based study of congenital talipes equinovarus. Paediatr Perinat Epidemiol. 2005;19:227-37.

Carroll NC. Congenital clubfoot: Pathanatomy and treatment. Instr Course Lect. 1987;36:117-21.

Carroll NC, McMurtry R, Leete SF. The pathoanatomy of congenital clubfoot. Orthop Clin North Am. 1978;9:225-32.

Dimeglio A, Bensahel H, Souschet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B. 1995;4(2):129-36.

Rebbeck TR, Dietz FR, Murray JC, Buetow KH. A single-gene explanation for the probability of having idiopathic talipes equinovarus. Am J Hum Genet. 1993;53:1051-63.

Lochmiller C, Johnston D, Scott A, Risman M, Hecht JT. Genetic epidemiology study of idiopathic talipes equinovarus. Am J Med Genet. 1998;79:90-6.

Chakraborty R. The inheritance of pyloric stenosis explained by a multifactorial threshold model with sex dimorphism for liability. Genet Epidemiol. 1986;3:1-15.

Turco VJ. Surgical correction of resistant clubfoot. One-stage posteromedial release with internal fixation: A preliminary report. J Bone Joint Surg. 1971;53:477-97.

Aggarwal ND, Singh HS, Mittal RL. Evaluation of tibialis posterior transfer on surgical treatment of congenital clubfoot. IJS. 1967;29:4-105.

Goldner JL, Fitch RD. Classification and evaluation of congenital talipes equinovarus. The clubfoot. 1994;120-39.

Varma HS, Agrawal AC, Singh PK. Surgical management of congenital idiopathic clubfoot by twin incisions. J Orthop Allied Sci. 2013;1:18-21.

Yamamoto H, Muneta T, Ishibashi T, Furuya K. Posteromedial release of congenital club foot in children over five years of age. J Bone Joint Surg Br. 1994;76(4):555-8.

Kaewpornsawan K, Khuntisuk S, Jatunarapit R. Comparison of modified posteromedial release and complete subtalar release in resistant congenital clubfoot: a randomized controlled trial. J Med Assoc Thai. 2007;90(5):936-41.

Yoneda B, Carroll NC. One stage surgical management of Resistant Clubfoot: J Bone Joint Surg. 1984;66:30.

Haasbeck JF, Wright JG. A comparison of the long-term results of posterior and comprehensive release in the treatment of clubfoot. J Pediatr Orthop.1997;17:29.

Roye DP, Roye BD. Long term results of Carroll’s approach: J Am Acad Orthop Surg, 2002;10:239-248.

Hwan-Tak H, Eng-Hin L. Surgical results of clubfoot using Carroll’s approach: J Orthopaedic Surg. 1997.

Porat S, Kaplan L. Critical Analysis of results in clubfeet treated surgically along the Norris Carroll approach; J Pediatr Orthop. 1989;9:137-43.