1. An operation which can correct congenital club foot deformity in older children is described. 2. The operation is based on the assumption that the essential element in a complex tarsal deformity is a displacement of the navicular bone on the talus and that all other elements of the deformity are secondary and adaptive. 3. The results of the operation are noted and the implications of some of its effects are discussed

1. Further consideration has been given to the lateral rotation which occurs at the ankle joint in uncorrected club feet. 2. Medial rotation osteotomy of the tibia may be used to restore more normal alignment to the hind foot at the expense of an increase in varus of the forefoot, which must be corrected at a second operation. 3. The early results in seven feet treated in this manner are reported. 4. We hope that this paper will be regarded more as a contribution to the understanding of the anatomy of uncorrected club foot than as advocacy of a new method of surgical treatment

Primary skin closure after surgery for club foot in children can be difficult especially in revision operations. Between 1990 and 1996 a soft-tissue expander was implanted in 13 feet before such procedures. Two were primary operations and 11 were revisions. A standard technique was used for implantation of the expander. Skin augmentation was successful in 11 cases. There was failure of one expander and one case of wound infection. Sufficient stable skin could be gained at an average of five weeks. Primary skin closure after surgery was achieved in 12 cases. We conclude that soft-tissue expansion can be used successfully before extensive surgery for club foot. The method should be reserved for revision procedures and for older children. The technique is not very demanding, but requires experience to achieve successful results

1. An anatomical study of congenital club foot in various stages of foetal development is presented, and the literature is reviewed. 2. The most striking finding was deformity of the talus and in particular a change in its angle of declination. 3. That deformity was present in feet whose deformity could not be corrected by gentle manipulation; it was absent in feet whose deformity could be so corrected. 4. Abnormality of the tendon and insertion of the tibialis posterior muscle was found in most cases. 5. Speculations are advanced concerning the nature and cause of the talar deformity

We analysed static footprints of 2300 children between the ages of four and 13 years to establish the influence of footwear on the prevalence of flat foot. The incidence among children who used footwear was 8.6% compared with 2.8% in those who did not (p less than 0.001). Significant differences between the predominance in shod and unshod children were noted in all age groups, most marked in those with generalised ligament laxity. Flat foot was most common in children who wore closed-toe shoes, less common in those who wore sandals or slippers, and least in the unshod. Our findings suggest that shoe-wearing in early childhood is detrimental to the development of a normal longitudinal arch

1. In a club foot the small inverted and elevated heel is considered to be the most important deforming influence in preventing complete correction and in promoting relapse. 2. Correction of the varus and an increase in the vertical height of the heel are achieved by opening up the medial aspect of the calcaneum and inserting a wedge of bone. This abolishes the inverting action of the calcaneal tendon and brings the heel down on to the ground directly under the line of the tibia so that it touches first in walking. The weight is then shifted on to the forefoot, as in the normal gait, thus producing gradual correction of supination and adduction. 3. The operation may have to be repeated, but with the varus fully corrected and a plantigrade heel there is no chance of relapse, and progressive improvement, not only in gait and shoe wear but also in the development of the foot and leg, can be expected. 4. Skin closure is a difficulty, and though the resulting scar is sometimes conspicuous, it is masked to some extent by being on the postero-medial aspect of the ankle. 5. The ideal age for the operation is about three to four years, but there is virtually no upper age limit. 6. In older patients presenting severe residual deformity it may be necessary to correct the heel and then the equinus of the forefoot by a tarso-metatarsal wedge, thus avoiding damage to the mid-tarsal and subtalar joints. 7. By adopting these principles, soft-tissue release operations, so often disappointing and sometimes damaging, can be avoided and in no patient should there ever be the need to resort to the mutilating "triple wedge" resection. 8. The most important feature of the operation is correction of the varus; it is better to over-correct than to under-correct (Figs. 20 and 21). It is a simple matter to deal with the valgus later if necessary

Between 1994 and 1997 we used the Ilizarov apparatus to treat 12 recurrent arthrogrypotic club feet in nine patients with a mean age of 5.3 years (3.2 to 7). After a mean of three weeks (two to seven) for correction of the deformity and 1.5 weeks (one to four) for stabilisation in the apparatus, immobilisation in a cast was carried out for a mean of 14 weeks (7 to 24). The mean follow-up period was 35 months (27 to 57). Before operation there were one grade-II (moderate), eight grade-III (severe) and three grade-IV (very severe) club feet, according to the rating system of Dimeglio et al. After operation, all the club feet except one were grade I (benign) with a painless, plantigrade platform. Radiological assessment and functional evaluation confirmed significant improvement. Two complications occurred in one patient, namely, epiphysiolysis of the distal tibia and recurrence of the foot deformity. These results suggest that our proposed modification of the Ilizarov technique is effective in the management of recurrent arthrogrypotic club foot in young children

We describe a new technique, known as coregistration imaging, which superimposes . 99m. Tc isotope bone scans on to plain radiographs. We used the technique selectively in cases in which the nuclear medicine physician, who reported the isotope scan, had difficulty in localising the anatomical site of the abnormality. In the forefoot, coregistration of isotope scans did not help to localise pathology; the scan alone gave sufficient detail. In 17 patients with pain in the hind- and midfoot, isotope scanning identified eight sites of abnormality in those with normal radiographs. In those with more than one abnormality on plain radiographs the isotope scan eliminated 12 sites of suspicion. Coregistration of the images significantly increased the certainty of localisation of disease (p < 0.001). We recommend the selective use of coregistration scanning as a useful technique for investigating patients with pain in the foot and ankle

We investigated 60 patients (89 feet) with a mean age of 64 years (61 to 67) treated for congenital clubfoot deformity, using standardised weight-bearing radiographs of both feet and ankles together with a functional evaluation. Talocalcaneal and talonavicular relationships were measured and the degree of osteo-arthritic change in the ankle and talonavicular joints was assessed. The functional results were evaluated using a modified Laaveg-Ponseti score. The talocalcaneal (TC) angles in the clubfeet were significantly lower in both anteroposterior (AP) and lateral projections than in the unaffected feet (p < 0.001 for both views). There was significant medial subluxation of the navicular in the clubfeet compared with the unaffected feet (p < 0.001). Severe osteoarthritis in the ankle joint was seen in seven feet (8%) and in the talonavicular joint in 11 feet (12%). The functional result was excellent or good (≥ 80 points) in 29 patients (48%), and fair or poor (< 80 points) in 31 patients (52%). Patients who had undergone few (0 to 1) surgical procedures had better functional outcomes than those who had undergone two or more procedures (p < 0.001). There was a significant correlation between the functional result and the degree of medial subluxation of the navicular (p < 0.001, r. 2 . = 0.164), the talocalcaneal angle on AP projection (p < 0.02, r2 = 0.025) and extent of osteoarthritis in the ankle joint (p < 0.001). We conclude that poor functional outcome in patients with congenital clubfoot occurs more frequently in those with medial displacement of the navicular, osteoarthritis of the talonavicular and ankle joints, and a low talocalcaneal angle on the AP projection, and in patients who have undergone two or more surgical procedures. However, the ankle joint in these patients appeared relatively resistant to the development of osteoarthritis

A method of triple arthrodesis is described which involves inlay of the subtalar and midtarsal joints. It is applicable to the undeformed and valgus foot as is encountered in poliomyelitis, spasmodic flat foot, cerebral palsy and spina bifida. The operation was successful in controlling deformity and pain. The only significant complication was failure of fusion of the midtarsal joint which occurred in three of eighty-five feet (3-5%)

Our goal was to evaluate the use of Ponseti’s method, with minor adaptations, in the treatment of idiopathic clubfeet presenting in children between five and ten years of age. A retrospective review was performed in 36 children (55 feet) with a mean age of 7.4 years (5 to 10), supplemented by digital images and video recordings of gait. There were 19 males and 17 females. The mean follow-up was 31.5 months (24 to 40). The mean number of casts was 9.5 (6 to 11), and all children required surgery, including a percutaneous tenotomy or open tendo Achillis lengthening (49%), posterior release (34.5%), posterior medial soft-tissue release (14.5%), or soft-tissue release combined with an osteotomy (2%). The mean dorsiflexion of the ankle was 9° (0° to 15°). Forefoot alignment was neutral in 28 feet (51%) or adducted (< 10°) in 20 feet (36%), > 10° in seven feet (13%). Hindfoot alignment was neutral or mild valgus in 26 feet (47%), mild varus (< 10°) in 19 feet (35%), and varus (> 10°) in ten feet (18%). Heel–toe gait was present in 38 feet (86%), and 12 (28%) exhibited weight-bearing on the lateral border (out of a total of 44 feet with gait videos available for analysis). Overt relapse was identified in nine feet (16%, six children). The parents of 27 children (75%) were completely satisfied. A plantigrade foot was achieved in 46 feet (84%) without an extensive soft-tissue release or bony procedure, although under-correction was common, and longer-term follow-up will be required to assess the outcome. Cite this article: Bone Joint J 2013;95-B:1721–5

This paper reports the results of bone scans on 78 painful feet. Scanning helped in the diagnosis of persistent foot pain following injury and it enabled stress fractures, fractures of the sesamoids and subtalar arthritis to be diagnosed earlier. It reliably excluded bone infection and was useful as a screening test when radiographs were normal

The clinical and pathological features of a pedunculated tumour of the left foot in a woman aged eighty-three years are recorded. The tumour had been present for forty years. Histologically, its pleomorphic structure was that of the "mixed tumour" of salivary gland with predominance of the myo-epithelial element. Its origin from sweat-gland tissue is presumed

Talectomy was performed on 10 patients (15 feet) for club foot deformity in arthrogryposis multiplex congenita. These were reviewed after an average follow-up of eight years. At follow-up nine feet were plantigrade, and six had less than 15 degrees residual equinus at the ankle. All the feet were asymptomatic but had mild residual adduction of the forefoot and marked stiffness of the hindfoot. Seven feet developed spontaneous bony ankylosis in the tibiotarsal joint. The common technical errors were incomplete removal of the talus and incorrect positioning of the calcaneus in the ankle mortise