Our daughter had surgery at age 18 months to correct a clubfoot that didn’t get better with casting. She’s now 11-years-old and wants to try out for the local girls’ soccer team. Should we try to discourage her and shield her from possible failure? Or let her try out and see what happens? I’m just not sure the leg is strong enough or that the surgery will hold up.

There aren’t a lot of studies with long-term results for surgical correction of clubfoot. Like your daughter, infants with equinovarus (medical term for clubfoot) are treated first with a conservative approach called the Ponseti method. This involves a series of casts used to gradually correct the alignment of the ankle and foot. This treatment is effective for 95 per cent of children born with this condition.

But if correction is not successful with this nonoperative care, then surgery is needed.
There are different surgical techniques used by different surgeons and results may vary because of that. For example, extensive soft-tissue releases may be performed to lengthen the tendons (e.g., Achilles, posterior tibialis, abductor hallucis brevis tendons) around the ankle.

The capsule (a tough fibrous structure) around the ankle joints may be cut. One surgeon from Northwestern University School of Medicine recently published long-term (20-year) results using a technique that involved these kinds of soft-tissue releases and wires to hold the bones in proper alignment.

There were a total of 80 children in the study. Some had bilateral clubfoot (both feet affected), so there was a total of 120 feet surgically corrected. For two-thirds of the group, the authors described the results as “acceptable” and “durable.”

The remaining one-third had to have additional surgery because the deformity was not fully corrected. No one needed to have the ankle fused. For the children who only had one foot involved, there was a significant difference in motion, calf size, leg length, and foot length between the two feet at the final check-up years after the surgery. Muscle strength was normal for half the group.

The possible weakness and difference in leg length, foot size, and coordination on the surgical side may impair your daughter’s playing ability. A physical exam involving tests and measurement of ankle/foot range of motion, strength, coordination, and proprioception (position sense of awareness) might be a good idea. It’s possible she will be fine to start out now and build strength with practice and play. But if she needs any further rehab to prepare her for safe sports participation, now is the time to find out.