Surgical treatment of the cleft foot

Between 1970 and 1997, we treated a total of 32 cleft feet in 21 patients ( 11 male and 10 female). We classified cases of cleft foot on the basis of t he number of central ray deficiencies. Fourteen patients with 22 cleft feet were followed up for more than 1 year postoperatively (9 feet had no or on e central ray deficiency, and 13 feet had two or three central ray deficien cies). The mean follow-up period was 8.8 years. The objective of this study was to evaluate the results of operative treatm ent of cleft foot. We evaluated the results of three methods: simple closur e of the cleft, application of a double-pedicled flap, and insertion of a s ilicone block. Cosmetic complications, including widening of the foot, hype rtrophic scarring, pigmentation of the grafted skin, and overlapping of the toes, were observed in patients xith two or three central ray deficiencies . Few functional complications were observed: None of the patients experien ced gait disturbances, although one patient complained of pain following wa lking. Roentgenography showed that the distance between the first and fifth metatarsals was 86 percent of that of the contralateral foot When treating patients with no or one central ray deficiency, satisfactory results can be expected with simple closure of the cleft. However, in patie nts with two or three central ray deficiencies, it is difficult to obtain s atisfactory results with simple closure of the cleft or application of a do uble-pedicled flap. Therefore, silicone block insertion to correct the defe ct is recommended when there is more than one central ray deficiency.