Osteotomy of the calcaneus and concomitant plantar stripping in children with talipes cavo-varus.

Cavo-varus deformity of the foot secondary to poliomyelitis, congenital club foot or other diseases is a rather complex deformity caused by imbalance of intrinsic and extrinsic muscles of the foot. Correction by tarsal reconstruction with or without soft-tissue procedures is the accepted form of treatment. However, in children too young for tarsal reconstruction the problem remains, because the deformity is progressive and structural changes in tarsal bones will occur despite conservative measures. Dwyer in 1955 presented a new approach. He advised correction of the varus deformity of the heel by removing a wedge of bone from the outer aspect of the calcaneus combined with subcutaneous division of the contracted plantar fascia. In this way the foot became plantigrade, and therefore weight-bearing exerted a corrective influence which resulted in progressive improvement of the deformity. In his opinion the operation was mainly a prophylactic one and should be performed before there was gross structural deformity and while active growth was still taking place. He reported sixty-three operations in forty-seven children and observed striking improvement in the deformity as well as in the gait ofthe children and the way their shoes were worn. Fisher and Shaffer(1970) reported a new method ofevaluation used in sixty-three calcaneal osteotomies. They assessed their results according to the improvement achieved separately in heel varus, cavus and forefoot adduction. Their results showed that calcaneal osteotomy was generally effective in correcting heel varus particularly in patients with club feet who required bony operation for correction but were too young for triple arthrodesis. They found the operation ineffective for correcting cavus and forefoot adduction. The present investigation was undertaken in order to assess the prophylactic value of this operation in a series of children most of whom were operated upon at an early age and followed for many years. The purpose was to ascertain whether the results achieved in young children remained unaffected by years of rapid growth, and whether tarsal reconstruction was needed by the end of that period.