Foot Reconstruction(Club- Foot etc..)

Club foot or congenital talipes equinovarus means a deformity by birth or since birth with a foot like a horse foot as congenital means since birth talipes is foot and euino means horse in greek.

INCIDENCE.

One in thousand live birds.Mostly sporadic occurrence and has been seen in Families as autosomal dominant trait with incomplete penetrance.Bilateral in 50%.

TYPES / FORMS.

No uniform classification, basically the deformity contains equinus varus and adduction varies in severity. The entire foot may be in equinus and varus position with the forefoot in adduction and cavus deformity present or only the foot in a mild equinus and varus. OPERATIVE TREATMENT.

Before going into the details of the operative techniques, it is necessary to have a vast knowledge about the deformity. .

In early 1970’s Turco attributed the deformity to medial displacement of the navicular and calcanius around the talus.According to him the talus is forced into equinus by the underlying calcanius and navicular. While the head and neck of the talus are deviated medially . .

Calcanius is inverted under the talus with posterior end displaced upwards and laterally and anterior displaced downward and medially. Herzenberg et al demonstrated with 3-D computer model that the talar neck is internally rotated relative to the ankle mortise; but the talar body is externally rotated in the mortise. .

Contractures of the soft tissues around the bones exert further deforming forces and resist correction. .

Laterally are the calcaneo fibular ligament, peroneal tendon sheath,posterior talocalcaneal ligament(resisting the realignment of the talocalcaneal joint) while resisting the talocnavicular joint are- tibialis posterior,deltoid ligament ,calceneonavicular or spring ligament, talonavicular capsule. .

Internal rotation of the calcaneocuboid joint causes contractures of the bifurcated Y ligament. The metatarsal are in adduction at the TMT joints. .

Treatment of resistant club feet is One of the most difficult problems in pediatric orthopaedics.As the deformity may take many forms and there are no clear cut guidelines.

Before Surgery	Fixator Treatment	After Surgery