Objective: Correction of skeletal deformity and restoration of muscle balance for the improvement of form and function of the foot.
Indications: Developmental vertical talus deformity (idiopathic form). Vertical talus in a developmental arthrogryposis multiplex or in neurologic diseases such as cerebral palsy or spina bifida.
Contraindications: Serious illnesses preventing anesthesia.
Surgical technique: Achilles tendon lengthening. Release of contracted parts of ankle capsule, of the talonavicular and the calcaneocuboid joints. Reduction of the hindfoot bones and fixation with Kirschner wires. Augmentation of the spring ligament. Further stabilization by an anterior transfer of the tibialis posterior tendon and a posterior transfer of the tibialis anterior tendon. In addition, in instances of severe deformities or inadequately treated feet before surgery, lengthening of extensor tendons and repositioning of anteriorly displaced peroneal tendons. For paretic feet transfer of the peroneus brevis tendon to the tendon of the peroneus longus or in instances of paralysis of the supinators transfer to the tendon of the tibialis posterior.
Results: This procedure was done in 74 feet of 45 patients. Follow-up of 59 feet in 35 patients after an average of 7 years and 3 months. At the time of surgery the youngest patient was 6 months old and the oldest 25 years and 6 months (average 4 years and 6 months). Assessment of results using the parameters of Walker et al. An average of 12.5 out of 16 points was reached. The loss of function was mostly due to the underlying diseases such as arthrogryposis, spina bifida or cerebral palsy. One pin site infection, one osteomyelitis, one pressure sore in the cast, and five wound healing disturbances were observed.