Conditions
1. Dynamic supination - weak peronei
2. Metatarsus adductus with curved lateral border of foot
3. Tight T achilles
4. Residual or recurrent equinovarus
5. Overcorrection / valgus
Options
Soft tissue procedures
Bony procedures
Metarsus Adductus
Algorithm
- depends on age
- depends if deformity in metatarsals or tarsus
Options
1. ST release
- abductor hallucis brevis + plantar fascia
- young < 5
2. MT osteotomies
- deformity distal to navicular
3. Lateral column shortening and medial ST release
- medial soft tissue release and medial column lengthening
- shortening of the lateral column - decancellation of cuboid / closing wedge osteotomy
4. TDRO / Tibial derotation osteotomy
Hindfoot EquinoVarus
Issues
Later age > 5
- soft tissue procedures insufficient
- bony procedures required
Options
1. Lateral sliding calcaneal osteotomy / lateral closing wedge osteotomy
- varus
2. Wedge tarsectomy
- correction of equinus
3. Talectomy
- rarely indicated
- arthrogryposis or severe neuralgic clubfoot
- resect cuboid also to maintain balance of columns
4. Ilizarov
- excellent salvage
- correction of equinovarus
Hindfoot valgus
Aetiology
Overcorrection
Options
Lambrinudi - for fixed equinus in patients 10 years or older
Triple arthrodesis
- good correction of all elements of club foot
- used in the late presenting child or late recurrence
- should not be used before foot has stopped growing because it shortens the foot / stops growth