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Year : 1976  |  Volume : 10  |  Issue : 2  |  Page : 124-126

The Role Of Early Partial Release Of Tendoachillis And The Posterior Capsule Of The Ankle Joint In The Management Of Untreated 'Good' Club Feet

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S. P Mehta

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Generally speaking by a ‘Good’ club foot, we mean a foot which appears to be well developed, the heal is soft and supple, the foot is not rigid and creases in the foot (at least in the immediate postnatal period) tend to open easily. Most of the parents of these children were poor and illiterate, and were hailing from the nearby as well as far off placed districts of the state (Gujarat) and on socio-economic grounds presented problems of repeated follow up in the management. Many children with ‘Good’ feet reported late for treatment and were from the age group if 3 to 6 months. The conventional conservative treatment in these patients necessitated numerous sittings of corrective plaster casts and at the end, it often to some extent a tight and an inturned tundo-achillis. Because of socio-economic reasons many children failed to turn up at the clinic after one or two corrective plaster sittings, and subsequently returned to the clinic with severe deformities. Settle (1963) has reported that the fibres of the achillis tendon were inserted vertically into the calcaneum, which was rotated into marked varus. As a result, when the calcaneum was placed in neutral position beneath the talus, the medical fibres were tighter than the lateral ones. Wiley (1959) considered that the deformed position (plantar flexion) constituted a bar to the correction of the deformities subsequently, and the effect of sample tenotomy of the tendo-achillis greatly facilitated correction of the two of the deformities (equines and inversion). Attenborough (1966) emphassised the role of earlier correction of hind foot, and also mentioned that the subtalar joint is always inverted, when the talus is plantar flexed. He also stressed that manipulative correction of the equines deformity all too frequently fails to do more than to produce a false correction by overstretching the midtarsal joints. From the foregoing discussion, it appears rationale to correct the equines deformity at the earliest in the children, who came late of the treatment. With a view a to correct the deformity in one sitting, a release of the medical fibres of the tendo-achillis and the posterior capsule of the ankle joint by a subcutaneous tenotomy was performed. We believe that a more radical surgery is called for in an untreated club foot in children over the age of 6 months, while correction by plaster casts is the treatment of choice for the children under the age of 3 months.

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