Calcaneus Deformity Research Articles

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.

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.

Treatment of spastic equinus by aponeurosis lengthening.

The aponeurosis lengthening described in this study was performed on 156 patients (219 procedures) with spastic equinus deformities. There was only one wound complication and no calcaneus deformities from overlengthening. The recurrence rate requiring relengthening was high (48% of the procedures), particularly if the initial operation was performed before the age of 5 years. The length of postoperative immobilization did not affect the recurrence rate. The aponeurosis lengthening technique described is a simple lengthening of the aponeurosis, leaving the soleus largely intact without the use of internal sutures. It has a negligible complication rate, but a high rate of recurrent equinus.

Grice Subtalar Arthrodesis Followed to Skeletal Maturity

Summary: A retrospective review of 45 patients (62 feet) who had undergone a Grice subtalar arthrodesis and who had reached skeletal maturity was undertaken. Preoperative deformities were due to flaccid and spastic paralysis, as well as congenital abnormalities. There were failures in 32% and poor results in 61%. Unrecognized anklevalgus, overcorrection of the hindfoot into varus, uncorrected calcaneus deformity, and anterior graft orientation largely contributed to the poor results. Weight-bearing radiographs of the feet and ankles are necessary to distinguish ankle valgus from hindfoot valgus. A subtalar arthrodesis cannot be used to compensate for ankle valgus, nor can it be used to correct the calcaneus component of a deformity without appropriate muscle-balancing procedures or osteotomies.

Grice Subtalar Arthrodesis Followed to Skeletal Maturity

A retrospective review of 45 patients (62 feet) who had undergone a Grice subtalar arthrodesis and who had reached skeletal maturity was undertaken. Preoperative deformities were due to flaccid and spastic paralysis, as well as congenital abnormalities. There were failures in 32% and poor results in 61%. Unrecognized ankle valgus, overcorrection of the hindfoot into varus, uncorrected calcaneus deformity, and anterior graft orientation largely contributed to the poor results. Weight-bearing radiographs of the feet and ankles are necessary to distinguish ankle valgus from hindfoot valgus. A subtalar arthrodesis cannot be used to compensate for ankle valgus, nor can it be used to correct the calcaneus component of a deformity without appropriate muscle-balancing procedures or osteotomies.

CALCANEUS DEFORMITY IN CEREBRAL PALSY

Most but not all calcaneus feet in cerebral palsied patients are iatrogenic. The cause is related to imbalance between plantarflexors and dorsiflexors in most instances. Injudicious heel cord lengthening, inadequate preoperative assessment of anterior tibial power, heel cord lengthening accompanied by gastrocsoleus neurectomy or transposition of peroneal and posterior tibial tendons, anterior to the malleoli, are all potential causes of calcaneus deformity in cerebral palsy.

Calcaneus deformity in cerebral palsy.

Most but not all calcaneus feet in cerebral palsied patients are iatrogenic. The cause is related to imbalance between plantarflexors and dorsiflexors in most instances. Injudicious heel cord lengthening, inadequate preoperative assessment of anterior tibial power, heel cord lengthening accompanied by gastrocsoleus neurectomy or transposition of peroneal and posterior tibial tendons, anterior to the malleoli, are all potential causes of calcaneus deformity in cerebral palsy.

The etiology, clinical features, and treatment of calcaneus deformity.

The etiology, clinical features, and treatment of calcaneus deformity.

Tendon Transfers for Peripheral Nerve Injuries of the Lower Extremity

1. Nerve injuries in the lower extremity not infrequently result in paralysis of the muscles innervated by the injured nerve. 2. Disability caused by residual paralysis can be reduced by appropriate muscle transfers. 3. Deformity must be corrected before muscle transfer. 4. The most useful transfers in the lower extremities are the transfer of the tibialis posterior tendon anteriorly for correction of the equinovarus deformity of peroneal nerve injury; the transfer of the tibialis anterior with or without the peroneus longus to the calcaneus to prevent calcaneus deformity caused by loss of the triceps surae; and the transfers of the biceps femoris and semitendinosus to the patella to replace a paralyzed quadriceps. 5. Stability in the lower extremity is of prime importance and, if significant foot deformity is present at the time of transfer, a triple or subtalar arthrodesis is indicated as an associated procedure in transfers about the ankle.

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.

Translocation of the Peroneus Longus in the Treatment of Paralytic Pes Calcaneus

The results of translocation of the peroneus longus in thirty-three children are reviewed. Progressive paralytic calcaneus deformity in a growing child was the indication for operation. A normally functioning peroneus longus and a calcaneus deformity in which the foot could be passively corrected to neutral were the essential prerequisites for operations. The operation was performed at an average age of the patient of 6.2 years. Development of bone maturity is not a prerequisite for this operation. Translocation of the peroneus longus reroutes the tendon behind the calcaneus under great tension. This converts the calcaneus deformity into equinus position at the time of operation and allows any residual muscle power of the triceps surae to function by restoring its mechanical advantage. There were no patients in whom operation was completely ineffective. In twenty patients the translocated tendon acted only as a tenodesis, correcting the deformity and preventing its further progression. In thirteen patients, active plantar flexion was achieved. Following operation, fixed equinus deformity occurred in seven patients and varus deformity in two. These deformities were amenable to later correction.

Regeneration of the lower femoral epiphysis; report of a case.

The Journal of Bone and Joint Surgery. British volumeVol. 36-B, No. 1 Clinical Reviews and StudiesFree AccessREGENERATION OF THE LOWER FEMORAL EPIPHYSISReport of a CaseR. Mckellar HallR. Mckellar HallSearch for more papers by this authorPublished Online:1 Feb 1954https://doi.org/10.1302/0301-620X.36B1.116AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByAcquired Calcaneus Deformity Secondary to Osteomyelitis of the Distal TibiaJournal of the American Podiatric Medical Association, Vol. 104, No. 1Loss of a condyle of the femur or tibia following septic arthritis in infancy: problems of management and testing of a hypothesis of pathogenesisStéphane Tercier, N. D. Siddesh, Hitesh Shah, K. M. Girisha, Benjamin Joseph1 August 2012 | Journal of Children's Orthopaedics, Vol. 6, No. 4Infection4 October 2011Regeneration of the proximal tibial epiphysis after infantile osteomyelitisREPORT OF THREE CASES WITH AN EIGHT- TO 22-YEAR FOLLOW-UPK. S. Song, H. K. W. Kim1 July 2005 | The Journal of Bone and Joint Surgery. British volume, Vol. 87-B, No. 7Growth disturbance after osteomyelitis of femoral condyles in infants8 July 2009 | Acta Orthopaedica Scandinavica, Vol. 55, No. 1Current pediatric referencesThe Journal of Pediatrics, Vol. 45, No. 2 Vol. 36-B, No. 1 Metrics Downloaded 97 times History Published online 1 February 1954 Published in print 1 February 1954 InformationCopyright © 1954, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

ANKLE FUSION FOR CORRECTION OF PARALYTIC DROP FOOT AND CALCANEUS DEFORMITIES

Recent reports have been published concerning the treatment of paralytic drop foot by means of posterior bone block operations. Admittedly, an appreciable percentage of unsatisfactory results has followed the use of this procedure.1Posterior bone block for paralytic drop foot was tried at the New York Orthopaedic Dispensary and Hospital, but the results were not satisfactory. Accordingly, the procedure was abandoned. Ankle fusion was adopted and has been used extensively for both drop foot and calcaneus deformities. During the five year period from 1934 to 1938 inclusive 106 ankle fusions were done in this hospital for the correction of paralytic deformities resulting from anterior poliomyelitis. Ankle fusion was done in 72 instances to correct drop foot deformity and in 34 instances to correct calcaneus deformity. The patients have been observed from year to year in the follow-up clinic, and the end results have been gratifying. DROP FOOT Among the