A modified Lambrinudi operation for drop foot.

The Lambrinudi arthrodesis for drop foot is a popular operation not only because it yields good results but also because fusion occurs more easily than in other methods. The Lambrinudi operation is usually indicated in the correction of talipes equinus or equinovarus. The chief features of the operation are : excision of a wedge of bone from the talus and calcaneum, including the subtalar joint ; excision of the calcaneo-cuboid joint and the lower part of the navicular bone ; and the insertion of the remainder of the talus between the navicular and the cuboid bones (Fig. 1). Performed in this manner, the operation gives excellent results in patients with moderately severe club foot, whether congenital or paralytic. However, in the very severe deformities the correction that can be obtained is not sufficient. The main obstacle to increasing the correction is that both the angle and length of the wedge of bone that can be taken from the talus and calcaneum are limited and cannot be extended sufficiently. Any modification of the operation designed to give sufficient correction to the severest club foot must increase the size of the wedge of bone taken from the talus and calcaneum, but must not depart from the principles of the Lambrinudi arthrodesis which gives such favourable conditions for sound fusion. In order to achieve this, the operation has been modified. The wedge of bone from the talus and calcaneum is removed, as is the whole of the navicular bone and the top part of the cuboid bone, thus extending the angle and length of the wedge (Fig. 2). The calcaneo-cuboid joint is resected widely. The lower halves of the cuneiform bones are excised as a whole so as to fit the remaining beak of the talus.