STABILIZING OPERATIONS ON THE FOOT

Abstract

1. An evaluation of 305 foot stabilizations, based on anatomical and functional end results, shows that stabilization was successful in 82 per cent. of the cases. Residual deformity or pseudarthrosis accounted for fifty-one of fifty-five failures. Over two-thirds of the residual deformities resulted from undercorrection at the time of operation. Listed in order of frequency, removal of the plaster before solid fusion had occurred, failure to align the foot with the ankle joint, pseudarthrosis, and loss of position in plaster or at the change of plaster were much more common as the causes of recurrence of deformity than muscle imbalance. 2. The results were more successful when three joints were resected. Mid-tarsal wedge osteotomy resulted in the highest percentage of failure and did not correct the foot varus. 3. Stabilization done on children up to and including eight years of age produced 47 per cent. of failures. In the group from nine to eleven years, inclusive, the results were as good as those in the series as a whole. 4. Varus and drop-foot were the most frequent deformities that remained undercorrected. Stabilization, with the exception of panarthrodesis, cannot be expected to correct drop-foot. 5. Pseudarthrosis occurred in 18 per cent. of the cases. Approximately one-fifth of the patients had such severe pain that a rating of failure was mandatory. In the fifty-six pseudarthroses, 89 per cent. were at the talonavicular joint. 6. Three-quarters of the revision procedures produced satisfactory results, indicating that repeated intervention was justified. 7. Measurement of the foot which had been operated upon disclosed that it averaged eleven-sixteenths of an inch shorter than the foot which had not been operated upon. The same foot-length discrepancy was present in eighty patients who had been operated upon before the age of twelve years. 8. These operations have been employed for many conditions, but by far the most common, in order of frequency, were poliomyelitis, spastic paralysis, Friedreich's ataxia, congenital club-foot, and painful flat-foot.