71: V Osteotomy of the Foot

Fig. 1

View of both legs in comparison

Fig. 2

Right leg in frontal view

Fig. 3

Medial side view of the leg before surgery

Fig. 4

Pictured: history of the prosthetic compensation of the defect of the leg

Fig. 5

Clinical view of the leg at birth

Fig. 6

Frontal radiograph of the leg before treatment

Fig. 7

Lateral foot radiograph and forefoot radiograph before treatment

3 Preoperative Problem List

(a)

Equinus deformity of the calcaneus and forefoot

(b)

Varus deformity of the calcaneus

(c)

Cavus deformity of the midfoot

(d)

Adduction and supination of the forefoot

(e)

Shortening of the entire foot and the leg

(f)

External torsion of the leg

4 Treatment Strategy

(A)

V osteotomy of the posterior calcaneus, talus, and anterior calcaneus of the foot for lengthening and progressive correction of the deformity by distraction with circular frame.

(B)

Osteotomy of proximal tibia and fibula for lengthening of the leg simultaneously with the foot correction.

(C)

Correction of all components of the deformity: cavus deformity, adduction and supination of the forefoot, varus, equinus, and adduction of the calcaneus.

(D)

The aim is to obtain a plantigrade foot and achieve lengthening of the leg in order to wear shoes without an orthopedic brace.

5 Basic Principles

V osteotomy is the universal type of osteotomy of the foot that permits correction of the complex foot deformity (Shalaby and Hefny 2007) separately of the hindfoot and forefoot. In the case of tibial hemimelia , where the deformity is really severe and rigid, V osteotomy became the only way for treatment with correction and lengthening. Simultaneously with foot correction, leg length discrepancy was treated by lengthening of the tibia and fibula in the proximal area. In the presented case with ankylosis of the ankle joint, application of the foot frame was simplified by not having to fix the talus with supplementary wires. Extensive lengthening of the foot bones, principally the calcaneus, should be achieved in order to correct the severely deformed hemimelic equinus foot and create a plantigrade foot.