RECONSTRUCTION OF A VARUS CLAW FOOT AS A SEQUELA OF A DEEP POSTERIOR COMPARTMENTAL SYNDROME OF THE LEG

Abstract

Introduction and purpose: Posttraumatic compartmental syndromes of the deep posterior compartment of the leg are usually given an incorrect diagnosis. There can be an involvement of the three muscles of the posterior compartment (albeit to different degrees) and muscle necrosis can cause a retraction that flexes the hallux and other toes as well as varus hindfoot and various degrees of equinus and cavus, hindering gait. We revised patients operated on who had had previous tibia and fibular fractures which had led to subsequent foot deformities.

Materials and methods: Seven patients were operated on in 5 years. The whole of the fibrous scar tissue was removed from the involved muscle and tendon and a medial capsule release was performed. A subtalar arthrodesis was carried out, laterally displacing the calcaneus under the talus, to correct the varus hindfoot. In addition a transplant of the FHL was made to the base of first phalanx as well as a transplant of the EHL to the base of the first metatarsal/tibialis anterior and a tenodesis of the distal end to EHB. The small toes were treated by means of a replacement of the extensor longus by the extensor brevis and an intrinsicoplasty of every toe.

Results: Using the AOFAS ankle and hindfoot scales, the mean postop score was e 90.8 points (range: 62–100), for hallux and small toes it was 90.2 points (range: 67–100). 5 patients (71.4 %) were considered to have obtained excellent results, 1 good and 1 poor. As regards complications, there was one instance of varus recurrence and one case of late consolidation.

Conclusions: Repair after a compartmental syndrome can be successfully carried out to achieve a plantigrade foot that allows ambulation.