[Non-familial ulcero-mutilating acro-osteopathy of the foot (Bureau-Barrière syndrome)]

We report on a case of severe acro-osteopathia ulcero-mutilans complicated by lethal endocarditis. The clinical course is presented with emphasis on the typical signs and symptoms. Diagnosis and treatment require a multidisciplinary approach to such patients.

The radiologic spectrum of abnormalities of the foot in diabetic patients

Radiologically visible lesions in the feet of patients with long-standing diabetes mellitus are common and varied. They include osteoporosis, osteosclerosis, osteolysis, juxta-articular defects of the cortical bone, ischemic bone necrosis, new bone formation, spontaneous fracture and subluxation, and neuropathic arthropathy. These manifestations result from diabetic angiopathy and neuropathy and usually are complicated by infection. In this review the author describes these protean radiologic features in light of their pathogenesis and discusses the diagnostic problems encountered.

Enlargement of the entire posterior aspect of the calcaneus: treatment with the Keck and Kelly calcaneal osteotomy

Painful enlargement of the entire posterior aspect of the calcaneus can be difficult to effectively treat and must be differentiated from a classical Haglund's deformity. Clinical, radiographic, and surgical treatments of this deformity will be discussed. An illustrative case presentation is also included.

[Effective operations of the foot. Report of experiences after 25 years of administration of the orthopedic department]

Report on proven methods of operation for the typical foot diseases. Particular emphasis is put on the possibilities for correction of many deformities of the foot through Chopart-arthrodesis by corresponding wedge-removal from the root of the foot, as underlined by Imhäuser. The Chopart-arthrodesis is especially suitable for treating weight-bearing complaints of mal-healed fractures of the calcaneum, because this procedure stabilizes the hindfoot and sets the mid- and forefoot plantarly. For post-operative recurrences of toe deformities, syndactily-operations are recommended.

Treatment of painful subluxation or dislocation at the second and third metatarsophalangeal joints by partial proximal phalanx excision and subtotal webbing

Pain at the second or third metatarsophalangeal joint associated with objective instability and roentgenographic displacement is a common forefoot problem. In 53 patients (60 feet), surgical correction of the painful deformity was completed by resecting the bases of the proximal phalanges of Toes 2 and 3 combined with subtotal webbing of the toes. At an average follow-up period of 29.8 months, 38% were wholly satisfied; 37%, satisfied with minor reservations; 15%, satisfied with major reservations; and 10% were not satisfied. When graded for pain, cosmesis, and footwear use, the most improvement was noted for pain symptoms. No significant effect of earlier forefoot surgery was noted. Residual complaints, such as persistent pain and unstable sensation of the webbed toes, were rarely disabling and usually minor compared to the preoperative status.

The dropped big toe

Surgical procedures for exposure of the upper third of the fibula have been known to cause weakness of the long extensor of the big toe post-operatively. The authors present three representative cases of surgically induced dropped big toe. From cadaveric dissection, an anatomic basis was found for this phenomenon. The tibialis anterior and extensor digitorum longus muscles have their origin at the proximal end of the leg and receive their first motor innervation from a branch that arises from the common peroneal or deep peroneal nerve at about the level of the neck of the fibula. However, the extensor hallucis longus muscle originates in the middle one-third of the leg and the nerves innervating this muscle run a long course in close proximity to the fibula for up to ten centimeters from a level below the neck of the fibula before entering the muscle. Surgical intervention in the proximal one-third of the fibula just distal to the origin of the first motor branch to the tibialis anterior and extensor digitorum longus muscles carries a risk of injury to the nerves innervating the extensor hallucis longus.

Cheilectomy: still a useful technique for grade I and grade II hallux limitus/rigidus

Cheilectomy, as applied to hallux limitus/rigidus, is described as resection of the dorsal osteophytes and lateral/medial margins of the first metatarsal, as well as the dorsal lip of the base of the proximal phalanx. Forty-seven patients underwent unilateral cheilectomy, with an average follow-up of 3.5 years, and an average patient age of 52 years. Dependent upon the progressive nature of the disease, the results varied with the most beneficial results in the early stages of hallux limitus/hallux rigidus, which include symptoms, re-operation, and range of motion. The indications for cheilectomy are hallux limitus/rigidus in grade I or grade II without sesamoid disease. Late grade II or grade III with sesamoid disease and degenerative joint disease are also described in terms of surgical treatment. The advantages of cheilectomy include early range of motion and rapid decrease in clinical symptoms; cheilectomy obviates the need for healing at an osteotomy site. The disadvantages include not addressing the underlying etiology, potential joint destruction, slippage, or pseudo-articulation at the joint's end range of dorsiflexion. It is not indicated in later stages of the disease.

Triple arthrodesis in the treatment of fixed cavovarus deformity in adolescent patients with Charcot-Marie-Tooth disease

Ten adolescent patients with Charcot-Marie-Tooth disease (12 feet) were evaluated an average of 7 years, 7 months following triple arthrodesis (TA) for the treatment of cavovarus deformity. The TA was the primary or index bone procedure. At follow-up, five feet were plantigrade, asymptomatic, and radiographically fused at all three joints. Three feet were plantigrade and asymptomatic, but two had talonavicular pseudarthrosis and one had calcaneocuboid pseudarthrosis. Three feet were radiographically fused at all three joints, but in nonplantigrade positions and symptomatic. One foot required a revision TA. In general, TA offers adolescent Charcot-Marie-Tooth patients a stable plantigrade foot in the face of a progressive disorder. The residual deformity, revision, and pseudarthrosis rates are similar to those for adults. Postoperative pain was related to a nonplantigrade foot and not to the presence of pseudarthrosis. It is not known whether a nonplantigrade foot was a result of incomplete surgical correction or recurrent deformity due to progressive muscle imbalance.

[Hallux rigidus and its treatment]

Hallux rigidus is a rather frequent, painful limitation of movements in the metatarsophalangeal joint of the great toe caused by arthrosis. A mechanical limitation of dorsal flexion due to osteophytes frequently causes a progressive plantar flexion with compensatory hypermotility in the interphalangeal joint. Therapeutic measures with technical modification of shoes and physical therapy are often insufficient and operative therapy aims at arthrodesis or remobilisation of the great toe's metatarsophalangeal joint.

Iatrogenic brachymetatarsia

The authors present a case report of iatrogenic brachymetatarsia. The literature was reviewed and various surgical treatments discussed. The metatarsal was lengthened using a sagittally placed Z lengthening step-up osteotomy, with an autogenous bone graft and rigid internal fixation.

Powered metaphyseal stapler: an effective and simplified internal fixation system used in multiple types of podiatric surgery

The multiplicity of types of usage of the powered stapler system in podiatric surgery were explored. The stapler system reduces surgical time and trauma, especially with complex reconstructive and repair procedures. The expedited surgical procedures along with minimized surgical trauma and comfortably implanted staples improved healing rate and less postoperative pain. The important criteria and indications for the usage of powered stapler fixation were reviewed. This relatively new system offers an effective alternative for internal fixation in the foot and ankle.

Functional hallux rigidus in the rheumatoid foot

Hallux rigidus results from arthritic involvement of the first metatarsophalangeal joint. The authors have observed loss of motion at this joint in patients with rheumatoid arthritis in the absence of hallux valgus or joint destruction. A hyperextension deformity of the interphalangeal joint has also been observed, with a painful callus beneath it. The first metatarsophalangeal joint appears normal on roentgenograms, and passive motion of the joint is normal when it is examined clinically. The loss of first metatarsophalangeal motion is functional, and stems from muscle spasm of the great toe intrinsic muscles in an effort to relieve pressure on the lesser metatarsal heads. The interphalangeal hyperextension may develop secondary to "functional hallux rigidus."

The treatment of ankle valgus by surface epiphysiodesis

Progressive ankle valgus in childhood requiring surgical correction is usually because of paralytic disease or conditions that produce a short distal fibula such as multiple exostoses or both. Surface epiphysiodesis of the distal medial tibial physis was used to correct valgus deformity in ten ankles in seven patients. This procedure has been found to be a simple and effective method of treatment. Measurement of the degree of valgus and calculation of the remaining growth of the distal tibial physis are recommended to determine whether this procedure will be effective. It is most often indicated in the presence of moderate valgus in children aged 11 to 14 years.

Hallux varus: a step-wise approach for correction

Iatrogenic hallux varus can be an unfortunate complication of hallux abducto valgus surgery. The correction of hallux varus must be performed in a well planned, step-wise method. The authors present both soft tissue and osseous corrections for hallux varus, with two case reports.

A systematic approach for radiographically evaluating joint disease in the foot

A methodic analysis of foot radiographs is valuable when evaluating for joint disease. The author presents a system that allows the interpreter to establish a list of expected differential diagnoses. This is especially useful when the arthritide does not present with its classic radiographic appearance.

Cystic rheumatoid arthritis: description of a nonerosive form

In a study of patients with rheumatoid arthritis (RA), 9% (n = 70) were found to have a cystic form. At radiologic examination of these patients with cystic RA, the first abnormality seen consisted of periarticular intraosseous cysts without erosions. The cysts were distributed symmetrically, most often located at the proximal side of the joints and predominantly around the proximal interphalangeal, metacarpophalangeal, and wrist joints of the hands and the first interphalangeal and metatarsophalangeal joints of the feet. Computed tomographic scans showed the peripheral intraosseous location of the cysts. Magnetic resonance images showed that the cysts may contain fluid, inflamed synovia, or both. Cysts can be an important feature in the diagnosis of RA and a supplement to the criteria of the American Rheumatism Association. Osteoporosis, joint-space narrowing, and joint destruction occurred less frequently in patients with cystic RA than in patients with classic RA. Of the patients with cystic RA, 54% were male, and 50% were seronegative. This study is a supplement to and an enlargement on earlier descriptions of cyst predominance in RA.

[Microsurgical autotransplantation in the correction of post-traumatic foot defects]

In the article is analyzed the experience of treatment of 211 patients with traumata, which are the results of thermal and irradiation foot injuries. 30 patients were subjected to microsurgical reconstruction with application of complex of tissular transplants. There were differentiated 3 types of foot tissue injuries, determining transplants and operative technique selection. It has been determined that the closure of ulcerous defects in case of post-thrombotic disease is possible with utilization of radial graft of forearm on long venous pedicle. Prevention of venous anastomosis thrombosis is contributed to by formation of peripheral arteriovenous anastomosis in the transplant. Impartment of the points of fixation of the muscular part with the locomotive nerve suture contributes to the increase of adequate reliability of musculocutaneous graft. Utilization of osseous transplant of iliac crest allows to perform an orthopaedic correction of the lost anterior part of foot and prevents limb amputation.

Radiographic examination of Chinese foot binding

The authors present a radiographic case report of foot binding in a probable Chinese female. The radiographs, taken in 1948, are from an archival collection and represent severe, prolonged deformities of the left foot. Information supplied by a visiting anthropologist from Shanghai, China, adds to a knowledge and understanding of the custom of Chinese foot binding in both the past and the present.

Posterior transfer of the anterior tibial tendon in children who have a myelomeningocele

Posterior transfer of the tendon of the anterior tibial muscle through the interosseous membrane to the calcaneus to prevent or correct a calcaneus deformity was performed in twenty patients (thirty-nine feet) who had a myelomeningocele. The average age of the patients at the time of the operation was 4.6 years, and they were followed for an average of six years. Satisfactory clinical and radiographic results were obtained in thirty-seven (95 per cent) of the thirty-nine feet. Two patients, one who was unable to walk and one who walked at home only, had a mild equinus deformity of the left foot. No patient had a clinical calcaneus deformity, but there was radiographic evidence of talipes calcaneus in one patient (two feet). The anterior tibial muscle functioned more consistently when the operation was performed after the patient was four years old and in patients who had a fifth lumbar or first sacral motor level.

Long term sequelae of frostbite

Frostbite injury in the hands and feet of a child can have long-term sequelae, Premature fusion and abnormal growth can occur in the epiphyseal cartilage.

Calcaneal osteotomy and tendon sling for the management of calcaneus deformity

A one-stage operation for severe post-poliomyelitic calcaneus deformity was done in seventy-seven feet of seventy-seven patients. The operation consisted of osteotomizing the calcaneus to increase the lever arm and to reshape the hind part of the foot and using a posterior sling formed from the peroneus brevis and tibialis posterior to provide plantar-flexion power. We were able to evaluate sixty-six patients more than three years after the operation. Most of the patients had improvement in the appearance and function of the foot as a result of the operation.

Correction of metatarsus primus varus with the Chevron metatarsal osteotomy. An analysis of corrective factors

A trigonometric evaluation of the amount of correction of metatarsus primus varus obtainable via lateral displacement of the first metatarsal head in a Chevron osteotomy technique revealed that approximately 1 degree of correction may be obtained for each millimeter of lateral shift. This calculated correction was correlated with the actual correction obtained in ten feet. Narrowing of the metatarsal head associated with removal of the medial eminence was an additional corrective factor.

Operation for calcaneus deformity after surgery for club foot

We describe three patients who developed gross calcaneus deformity following surgery for talipes equinovarus. One also had an associated valgus deformity and another had supination of the forefoot; all had intractable problems with footwear. Operation for transfer of the tibialis anterior to the heel, with correction of the associated deformities, was successful and improved both their gait and the shoe problems.

Osteochondral defects of the first metatarsal head in adolescence: a stage in the development of hallux rigidus

The cases are presented of five adolescents in whom there was an osteochondral defect of the first metatarsal head. The significance of this lesion is discussed.

Tibiotalocalcaneal arthrodesis for arthritis and deformity of the hind part of the foot

We devised a method for tibiotalocalcaneal arthrodesis to treat deformities or degenerative arthritis, or both, that involve the tibiotalar and talocalcaneal joints. Satisfactory results were obtained in approximately 75 per cent of twenty-one patients; osseous union was radiographically evident in all but three patients. Secondary degenerative changes in the adjacent joints were not evident radiographically during a period of follow-up that ranged from 2.5 to seven years.

Pathophysiology of Charcot-Marie-Tooth disease

The etiology of the foot deformity in patients with Charcot-Marie-Tooth disease has not previously been discussed in relation to the extrinsic muscle function around the foot and ankle. Eight adult patients with a strong familial history were evaluated, and their foot findings were remarkably similar. All demonstrated a marked cavus deformity that was secondary to a forefoot equinus associated with contracture of the plantar fascia and a varus deformity of the calcaneus. The muscle function demonstrated marked weakness of the tibialis anterior and peroneus brevis muscles, whereas the peroneus longus and posterior calf muscles were rated as good to normal. Based on the relative strengths of these muscles and the progression of weakness, the authors hypothesize that the deformity observed in patients with Charcot-Marie-Tooth disease is secondary to the weakness of the tibialis anterior, peroneus brevis, and the intrinsic muscles, with their natural antagonists, the peroneus longus and the tibialis posterior muscles causing most of the deformity noted in these adult patients.

Basal osteotomy of the first metatarsal for the correction of metatarsus primus varus associated with hallux valgus

At the University of Vienna Department of Orthopaedics, 26 feet in 21 patients were treated with a basal osteotomy for hallux valgus associated with metatarsus primus varus. In 85% of the cases, a satisfactory result was achieved. Critical analysis revealed shortening of the first metatarsal and elevation of its head, which resulted in excess lateral straining of the foot and metatarsalgia. In 15 cases, osteoarthritis in the metatarsocuneiform joint was also increased. Given these results, an osteotomy that prevents shortening of the first metatarsal and elevation of the head of the first metatarsal, or one that takes these facts into account, seems ideal.

Metatarsal head resection for rheumatoid deformities of the forefoot

Thirty-five feet in 21 patients, who had had metatarsal head resection for painful rheumatoid forefoot deformities, were analyzed retrospectively. All patients but one were allowed to ambulate 48 hours after surgery. The follow-up period averaged 29 months. A grading system was devised to assess the clinical results based upon pain relief, capacity to ambulate, shoe wear, cosmesis, and use of walking aids. Using this system, the results were 46% excellent, 34% good, 17% fair, and 3% poor. One patient developed a superficial wound infection, which healed uneventfully. Bony impingement was observed on follow-up roentgenograms of 67% of the resectional arthroplasties. This finding was generally asymptomatic, and it did not correlate with the clinical outcome. Smooth wire fixation was used in some of the feet, but it did not improve the results either roentgenographically or clinically.

[Diabetic osteoarthropathy. Course and differential diagnosis]

Diabetic neuropathy with reduced sensitivity to pain and mechanical overloading of the joints, associated with frequently disturbed circulation in the lower extremities, are the etiopathogenetic factors of diabetic osteoarthropathy (synonyms: neuroarthropathia diabetica, Charcot joint). In the first stage there is osteonecrotic destruction of bone and cartilage. Clinically, an insidious, painless, noninflammatory hydroarthrosis with massive swelling of the soft tissues is typical. Subsequently, in stage II, irregular transformation of the bone due to multiple resorptive processes occurs. In the third stage this transformation process stabilizes and the bone ends become more pointed and more sclerotic (resembling a licked candy stick). For mechanical reasons, the tarsometatarsal and metatarsophalangeal joints and the metatarsals are primarily affected. However, destruction is also seen in Chopart's joint, the talus, the calcaneus, the ankle joint and the distal tibia. With regard to differential diagnosis, similar clinical pictures are seen in many neuropathic bony changes--tabes dorsalis, syringomyelia, myelodysplasias, congenital analgesia, congenital familial acroosteolysis. More difficult to differentiate are osteomyelitic foci, bone tuberculosis, and malignant bone tumors involving bone destruction.

The results of tenodesis of the tendo achillis to the fibula for paralytic pes calcaneus

Sixty-six consecutive tenodeses of the tendo achillis to the fibula were done in sixty patients who had paralytic pes calcaneus. The patients were followed for an average of 5.7 years (range, two to 10.8 years). The preoperative disturbance of gait was eliminated in all of the patients, and radiographic improvement was noted in the feet that had been operated on. Sixteen feet (23 per cent) required revision of the tenodesis because equinus deformity had developed. The development of equinus deformity was found to occur more often in patients who had the procedure at a younger age and in patients in whom the calcaneotibial angle measured more than 70 degrees at the time of the tenodesis. Residual cavovarus deformity was successfully treated by a plantar release.

Deformation of the adult rheumatoid rearfoot. A radiographic study

Three hundred ninety-seven adult rheumatoid feet were examined. Those in whom pain had been present since the onset of the disease were compared radiographically with the painless feet in standing position: examination of the talar angle and of the internal arch showed flattening on the affected feet. The calcaneal angle, on the other hand, showed no difference between the two groups, but this latter parameter is little affected by the valgus pronation deformity of the hindfoot most often seen in patients who had experienced foot pain.

[Radiological picture of the hand and foot in systemic lupus erythematosus]

A detailed examination of the hands and feet was performed in a group of 34 patients affected by systemic lupus erythematosus (SLE), using low-dose mammographic film and Rank Xerox selenium plate, according to current diagnostic techniques. All patients presented articular symptoms (pain and arthralgia). The high incidence (38,8%) of patients with no radiographic evidence of bone damage-even though articular symptoms are present-is emphasized. In such cases, it is very difficult to distinguish SLE from rheumatoid arthritis, especially as far as therapeutic management and prognosis are concerned. The lack of any "pathognomonic" radiological sign of the lupus arthritis, in the hands as well as in the feet, is then stressed. Nevertheless, arthropathy in SLE is defined as a deforming non-erosive arthritis, with a typical symmetric distribution, affecting most commonly-according to incidence-the proximal interphalangeal and metacarpophalangeal joints. In the hand, arthropathy is referred to as Jaccoud's type arthritis, because it is characterized by joint deformities which can be corrected. In the foot, the main abnormalities include hallux valgus, subluxation of the metatarsophalangeal joints and widening of the forefoot.

Crossover second toe deformity

The crossover second toe deformity occurs when the lateral collateral ligament and joint capsule of the second metatarsophalangeal joint deteriorate. The second toe initially deviates in a medial direction but with time deviates dorsally and crosses up and over the great toe. A total of 17 patients (22 toes) were evaluated and 11 patients (15 toes) underwent surgical correction. A 90 degree satisfactory rate was noted at 42 months follow-up.

The late results of tarsometatarsal joint injuries

The late results of tarsometatarsal injuries in 33 patients have been reviewed. The average follow-up period was 15 years (range 11 to 20 years). Methods of treatment included cast immobilisation, and closed or open reduction with or without internal fixation. All patients noted diminishing symptoms after injury and all but six returned to their former occupation. Neither the initial fracture type nor the treatment had any apparent bearing on subsequent function; nor was there any correlation between radiographic assessment of the injury and the patient's symptoms.

Green-Grice extraarticular subtalar arthrodesis: results using a fibular graft

Thirty-six extraarticular subtalar arthrodeses were reviewed retrospectively to ascertain our long-term results and to determine the better grafting material, tibial corticocancellous bone or a fibular strut graft. The 21 patients had flexible planovalgus deformities due to various etiologies. Overall, satisfactory results (fusion, no pain, and correction of the deformity) were achieved in 83.3% of patients and unsatisfactory results (residual pronation) in 8.3%, and failures (marked pronation or graft resorption) occurred in 8.3%. The fibular strut graft had a better overall success rate, fewer complications, an easier acquisition, and achieved union where the tibial corticocancellous graft failed.

Pseudodiastrophic dysplasia: a distinct newborn skeletal dysplasia

Pseudodiastrophic dysplasia is a distinct disorder that differs from diastrophic dysplasia on the basis of clinical, radiographic, and chondro-osseous histopathologic findings. In addition to the rhizomelic shortening of the limbs and severe clubfoot deformity, which suggest the diagnosis of diastrophic dysplasia, distinguishing features are elbow and proximal interphalangeal joint dislocations, platyspondyly, and scoliosis, which are observed in infancy. This disorder has been reported previously in three infants, all of whom died in the first year of life. Two of these were sisters, suggesting autosomal recessive inheritance. We report four new patients with this distinct skeletal dysplasia, including two children now older than 4 years of age. In both of these patients neonatal contractures have improved with physical therapy and scoliosis has progressed significantly.

[Congenital and acquired foot deformities in the x-ray picture]

In addition to general radiologic aspects there are special orthopedic considerations in interpretation of x-rays of the foot. This is especially important for the diagnosis of orthopedic foot diseases. In clubfoot x-rays are useful for therapeutic planning and control. Even in the first months of life radiographs can show important disturbances of growth of the foot and displacement of the bones of the tarsus. In other congenital foot deformities x-rays are important for diagnostic reasons: they prove luxations or skeletal deformities. The most important acquired foot disease is the pronating foot. X-rays do not only show the amount of joint damage and structural changes of bones but also allow to draw conclusions to be drawn about the causes of static and dynamic changes of the foot skeleton. Functional diagnostic radiological investigation is of decisive importance for evaluation of infantile pronating foot. X-rays allow the differentiation to be made between physiological and pathologic changes. Subtle radiographic investigation is essential while planning operative treatment in childhood, as in adults.

[X-ray diagnosis of foot deformities]

In order to analyze foot deformities, the foot is divided into three compartments. Their normal and pathological positions are defined by the alignment of the bones' axes. The various foot deformities can be put down to a malalignment of the particular compartments. X-ray analysis of the malalignment allows a diagnosis to be made. The most important congenital and acquired foot deformities are discussed.

[Osteonecrosis of the child's foot]

On the basis of defined diagnostic elements, numerous conditions described in the literature as osteonecrosis are divided up into rare and questionable forms of osteonecrosis, on the one hand, and distinguished from definite, spontaneous osteonecrosis form the other. The clinical and radiological characteristics are often in agreement with the course of the disease. These aspects are presented and the more up-to-date studies on the etiology are cited. The two forms of definite, spontaneous osteonecrosis of the foot in children are described extensively, and typical courses are illustrated.

Effect of unilateral weight-bearing on pelvic limb development in broiler fowls: morphological and radiological findings

Twenty-five broiler chickens, which habitually adopted a unilateral weight-bearing stance, were studied. In all cases the contralateral limb was held free of the ground, normally as a result of gross valgus angulation of the intertarsal joint. The left pelvic limb was more frequently weight-bearing than the right which suggests that a pattern of limb dominance may occur in broiler fowls. Metaphyseal lesions, suggestive of dyschondroplasia, were more common in the load-bearing limb. This suggests that altered load-bearing or posture can initiate or exacerbate dyschondroplasia in susceptible birds. The load-bearing limb also showed altered patterns of bone torsion. These findings are similar to those observed in induced physeal (growth plate) osteochondrosis in mammals and the pathogenesis of lesions is likely to be similar.

Triple arthrodesis. A critical long-term review

The results of triple arthrodesis performed in 80 feet and followed for an average of 13 years are reviewed. Although the majority of patients were very pleased, the results of objective assessment were less favourable. There was a high incidence of degenerative joint changes in the ankle and midfoot and also of pseudarthrosis, avascular necrosis of the talus and residual deformity. Pre-operative rigid equinovarus deformity produced the majority of the poor results. It is suggested that bony resection alone might not be the best means of correcting severe equinus.

The short foot syndrome--an unfortunate consequence of neglected raised intracompartmental pressure in a severe hemophilic child: a case report

The vast majority of bleeding episodes in hemophilia occur in the musculoskeletal system. When bleeding occurs, within a closed compartment, the possibility of neurovascular compromise must be suspected. We present an interesting case where this danger was overlooked in a young hemophiliac boy and resulted in bone growth retardation and permanent deformity.

The Batchelor-Grice extra-articular subtalar arthrodesis

A new technique is described for extra-articular subtalar arthrodesis; it combines the main elements of the Batchelor and the Grice procedures. Results were reviewed after a minimum of three years. Of the 25 feet treated 24 had solid fusion and had maintained the operative correction of the valgus deformity; the one non-union was due to deep infection.