Medial subtalar stabilization with posterior medial release in the treatment of varus feet: a preliminary report

The problem of the varus hindfoot in children ages six to 10 has been discussed. A preliminary follow-up is presented on six patients treated by extensive medial release, multiple tendon lengthenings, and subtalar intra-articular arthrodesis. Two of our patients revealed incomplete correction of the deformity because of technical errors in the medial release. However, there have been no failures of fusion and no progression of the deformity to date. This is a preliminary report and further follow-up is indicated. It should be noted that we have now extended our series to 40 patients.

Simultaneous arthrography of the talocrural and talonavicular joints in children. I. Technique

A method is described by which simultaneous arthrography of the talocrural and talonavicular joints is performed on neonates and small infants with a high degree of success and a very low risk of complications. From films exposed in exact, standardized projections, valuable and highly reproducible information is obtained about the configuration of the talus, the shapes and mutual relationships of the joint surfaces, and any obliteration of the recesses. One disadvantage of the method is the need for general anaesthesia.

The importance of gastrocnemius recession in the correction of equinus deformity in cerebral palsy

Spasm or contracture of the gastrocnemius muscle is predominantly responsible for the equinus deformity of the foot in cerebral palsy. Its release is therefore logical in the treatment of all cases which do not respond to conservative measures. The authors have demonstrated, by the use of metal markers and radiographic control at operation, that adequate release cannot be achieved by severance of the calcaneal tendon alone, and that in order to ensure relaxation of the gastrocnemius muscle, the operation of choice is gastrocnemius recession by the method of Strayer, coupled with lengthening of the calcaneal tendon to deal with such degree of the deformity as may be attributable to shortening of the soleus. A survey of 100 limbs treated by this method revealed a recurrence rate of equinus of 9% and a degree of calcaneus deformity resulting in inadequate push-off in 3% of cases after an average follow-up period of six years.

Cavus deformity of the foot after fracture of the tibial shaft

Twenty-three cases of claw foot with limited talocrural and subtalar mobility were the result of muscle contracture of the leg after tibial-shaft fracture. A roentgenographic study including arteriography was performed. It was concluded that the typical short cavus foot is due to fibrous contracture of the muscles in the deep posterior compartment caused by vascular damage, swelling in the deep posterior compartment, or severe muscle laceration. On physical examination the distance between the lateral malleolus and the Achilles tendon was shortened in comparison with the sound side in all cases. This was found to be caused by dorsiflexion in the talocrural joint coincident with adduction in the mid-tarsal joint. The angulation of the foot forced the patients to rotate the leg outward in order to get the feet in parallel position for walking. This deformity could be misinterpreted as an inward malrotation of the tibial fracture. In severe cases a derotating three-dimensional wedge osteotomy of the distal part of the tibia was performed with promising results.

Calcaneo-valgus deformity

A discussion of the essential deformity in calcaneo-valgus feet develops a theme originally put forward in 1961 on the relapsed club foot (Evans 1961). Whereas in the normal foot the medial and lateral columns are about equal in length, in talipes equino-varus the lateral column is longer and in calcaneo-valgus shorter than the medial column. The suggestion is that in the treatment of both deformities the length of the columns be made equal. A method is described of treating calcaneo-valgus deformity by inserting cortical bone grafts taken from the tibia to elongate the anterior end of the calcaneus.

Hammertoe surgery: waist resection of the proximal phalanx, a more simplified procedure

A technic for correcting hammertoe and other toe deformities by waist resection of the proximal phalanges of the toes effectively corrected these conditions in 95 patients and 466 toes. This procedure can be done quickly and easily with low morbidity. Through a very short incision over the waist of the proximal phalanx, a subperiosteal resection is carried out which permits settling of the resected bone ends together within the periosteal tube, resulting in bony union. The proximal phalanx is effectively shortened and the imbalance of the tendon length to the bony arch, which originally produced these deformities, is thereby corrected.

Acquired hallux varus: a preventable and correctable disorder

Acquired hallux varus deformity of either the static or the dynamic type results from surgery to correct hallux valgus deformity and the accompanying bunion. The dynamic type is disfiguring, uncomfortable, and disappointing to the patient and surgeon alike. Linear as well as rotational forces are at work to produce the deformity. When recognized early, before fixation of the first digit has occurred in the deviated and clawed position, resection of the base of the proximal phalanx will correct the deformity. More radical treatment is required in the patient who is treated late. The experience with seven feet of five patients with acquired hallux varus deformity is presented here.