Obstinate Club Foot with Triple Plus Dislocations (A Unique Presentation)

This is the first such case with unique pathoanatomy seen in the last more than 50 years. Even after numerous surgeries and in unusual situations, like this one, resistant/rigid club foot, a frequent orthopedic issue, continues to be unresolved. This is especially true when we encounter abnormalities in older children, teenagers, or adults. Resistant/rigid club foot, a common orthopedic problem, still remains an unsolved problem, especially, when we come across deformities in older children, adolescents or adults, after multiple surgeries and sometimes unique cases, like this one. This case had unique pathoanatomy, due to congenital factors, increasing age and persisting with vengeance in spite of two earlier surgeries. Before planning another surgery, it was imperative to diagnose the actual cause, i.e. the unique patho- anatomy. Various other surgical options were not expected to give the desired result due to this unique pathoanatomy. The author has been in club foot research since long and the concept of this research has been based on pathoanatomy and its total correction. During this research process, there have been numerous need based modifications from time to time, based on applied interpretations of pathoanatomy, to make it effective in all resistant club feet, at any age, including adolescents and adult, which have been used in a large series with adequate follow-up in the past 25 to 30 years, with gratifying results. The landmark modifications have been: giving a generic name obstinate club foot given to every imaginable rigid club foot of any age, a substitute for multiple names found in literature; surgical technique named as Dolarz technique incorporating Z-plasties in dorsolateral rotation skin flap (DOLAR); a modifi- cation of the earlier technique already reported in the literature and not likely to succeed.Subtotal subtalar release refers to the modified extended deeper extensive soft tissue and osseous release in addition to the skin flap (SSR). The Dolarz approach was used to treat the current instance, although with some more recent alterations. Each phase was longer and more thorough, concentrating on triple plus dislocations, and included an original cuboid sliding osteotomy for full repair. For a satisfying outcome, awareness of the diagnosis and thorough preoperative planning were necessary. Inflexible and recurrent obstinate club foot Clubfoot, Dolarz surgical method, subtotal subtalar release Besides the skin flap, the modified extended deeper extensive soft tissue and osseous release was named as subtotal subtalar release (SSR). Treatment of the present case was by Dolarz technique, with some newer modifications. Each step was more extensive focusing on triple plus dislocations, including an innovative sliding osteotomy of cuboid for complete correction. Awareness for diagnosis and good preoperative planning was essential for gratifying result.