Anterior Distal Tibial Hemiepiphysiodesis Safely Corrects Recurrent Clubfoot Equinus in Growing Children: Meta-Analysis

Managing persistent or recurrent equinus deformity in skeletally immature children with clubfoot represents a substantial clinical challenge when primary soft-tissue releases or serial casting fail to maintain plantigrade foot alignment. To address the clinical evidence gap regarding joint-preserving guided-growth options, Varun Garg, Md Zafar Iqbal, Anil Agarwal, Priyanjal Jakhar, Surinder Kumar, and Mridushman Medhi conducted this systematic synthesis to define the efficacy and safety of anterior distal tibial hemiepiphysiodesis in this pediatric population.

Therefore, the systematic review and meta-analysis evaluated seven clinical studies involving 102 skeletally immature children (134 feet) over a mean follow-up of 27 months. Assessed using the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool, the study measured key outcomes including ankle dorsiflexion gain, Anterior Distal Tibial Angle (ADTA) correction, monthly correction velocity, and complications.

Key Clinical Findings of the Review Includes:

• Dorsiflexion Gain: Meta-analysis demonstrated a statistically significant improvement in overall ankle dorsiflexion with a pooled mean difference of −8.64° (P = 0.0008).
• Deformity Reduction: Analysis confirmed a statistically significant reduction in the ADTA with a mean difference of 14.40° (P < 0.00001).
• Correction Velocity: Data established a consistent, quantifiable rate of angular correction averaging 0.70° per month following hemiepiphysiodesis.
• Complication Profile: Review documented an overall postoperative complication rate of 15.7% across the evaluated pediatric cohort.
• Evidence Base: The investigation synthesized outcomes across seven studies involving 102 children and 134 treated feet over a 27-month follow-up.

The results suggest that anterior distal tibial hemiepiphysiodesis is a reliable and effective guided-growth salvage option for correcting recurrent equinus in skeletally immature clubfoot patients, achieving a mean dorsiflexion gain of −8.64° (P = 0.0008) and an ADTA correction of 14.40° (P < 0.00001). Furthermore, the intervention delivers a steady correction rate of 0.70° per month while maintaining an acceptable 15.7% complication rate over a mean 27-month follow-up.

Thus, the review concludes clinicians treating skeletally immature pediatric patients with persistent clubfoot equinus may consider anterior distal tibial hemiepiphysiodesis as a minimally invasive guided-growth alternative prior to performing extensive open surgical reoperations.

Although the analysis is limited by the predominantly retrospective nature of the included Level IV studies, future prospective randomized trials with standardized long-term follow-up are warranted to further refine patient selection criteria and long-term treatment protocols.

Reference

Garg V, Iqbal MZ, Agarwal A, Jakhar P, Kumar S, Medhi M. Anterior Distal Tibial Hemiepiphysiodesis for Recurrent Equinus in Clubfoot: A Systematic Review and Meta-Analysis. Indian Journal of Orthopaedics. Published online September 7, 2026.