Reverse club foot. Rigid and recalcitrant talipes calcaneovalgus

Malunited calcaneal fracture: the role and technique of osteotomy-a systematic review

PURPOSE

The research is aimed to introduce various corrective osteotomies utilized in treating calcaneal malunions in published papers, to further analyze the results, and to summarize recommended indications.

METHODS

The relevant research screening was conducted on the following search engines: the Cochrane Library, Web of Science, PubMed, Embase, Medline, and Academic Search Premier. Key words input included "calcaneal/calcaneus", "malunion," and "malunited fracture(s)" with Boolean operators "AND" and "OR." The inclusion criteria were researches containing surgical procedures treating calcaneal malunion with corrective osteotomy and published in the English language. For included research article, such information was extracted and analyzed: the type of calcaneal malunion, the time from initial injury to corrective surgery, the method of osteotomy, outcomes of each osteotomy (score systems, Bohler angle, talocalcaneal height and width of calcaneus, etc.), the function of the affected limb, post-operative complications, and patients' satisfaction. For included review, descriptive, commentary, or indicative sentences about corrective osteotomy were highlighted, analyzed, and summarized.

RESULTS

Ten research articles (170 patients with 184 feet) and nine reviews were included in this review, presenting seven types of corrective osteotomies (lateral wall exostectomy, Dwyer osteotomy, lateral wedge opening osteotomy, Romash osteotomy, tongue osteotomy, sagittal resection osteotomy, and modified Dwyer osteotomy).

CONCLUSION

A different corrective osteotomy with/without arthrodesis is recommended to be utilized based on the classification of the malunion and the condition of the cartilage in treating malunited calcaneal fractures. With adequate postoperative care and rehabilitation, the results of treatment could be associated with patients' satisfaction and good function.

Managing Severe Foot and Ankle Deformities in Global Humanitarian Programs

The severe foot and ankle deformities the authors' organization has encountered in humanitarian programs worldwide are more complicated than those surgeons treat in daily practice in developed countries. Severity of deformity, patients' economic limitations, patients' expectations and realistic needs in life, availability of surgical instrumentation, the local team's understanding of foot and ankle surgery and their ability to do consultation for patients postoperatively, and compliance of patients all account for success of the surgery. Regardless of the effort surgeons make, complications and recurrence occur. Educating and training local surgeons to take over medical care are the most important goals of the programs.

Management of valgus extra-articular calcaneus fracture malunions with a lateral opening wedge osteotomy

A total of 34 cases of symptomatic valgus deformity of the hindfoot secondary to a malunited extra-articular calcaneal fracture were corrected with laterally based open wedge calcaneal osteotomy. The pre- and postoperative radiographic parameters were compared, and a postoperative clinical evaluation was performed using the American Orthopedic Foot and Ankle Society ankle and hindfoot scoring system. The mean follow-up period was 56.2 (range 24.1 to 97) months. The most significant radiographic changes were improvement in the talonavicular coverage angle (mean 17.3°) on the anteroposterior view. The mean postoperative American Orthopedic Foot and Ankle Society hindfoot and ankle score was 90, with 23 excellent, 8 good, and 3 poor results. Laterally based opening wedge osteotomy of the calcaneus is effective in the management of a valgus heel resulting from malunited extra-articular calcaneal fractures. Lateral decompression of the peroneal tendons and the sural nerve was achieved indirectly through opening wedge lateral calcaneal osteotomy that shifted the weight-bearing axis laterally.

Review of Elmslie's triple arthrodesis for post-polio pes calcaneovalgus deformity

Twelve patients with residual talipes calcaneovalgus deformity due to poliomyelitis were reviewed. A two-stage Elmslie's arthrodesis was performed on nine patients with rigid deformity. Tendon transfer (peroneus brevis in one, peroneus brevis and longus in two) to the tendo Achillis insertion is used to correct the calcaneus deformity, after reduction of the calcaneus in the subtalar joint, using a Steinmann pin passed through the calcaneus. Good results were obtained in patients treated by arthrodesis. However, the deformity recurred in patients treated only with tendon transfer.