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Cuboid Osteotomy Associated With Plantar Medial Release in Severe Untreated Clubfoot

January 01, 2012

Contributors: Francesco Traina, MD, PhD; Francesco Acri, MD; Maria Teresa Miscione, MD; Matteo Nanni, MD; Danilo Leonetti, MD; Mohammadreza Chehrassan, MD; Stavroula Pagkrati, MD; Sandro Giannini, MD; Cesare Faldini, MD; Cesare Faldini, MD

Keywords: Bony Procedure

Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.
Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.

The idiopathic congenital clubfoot or equinovarus consists of a deformity of the foot in equinus, varus, and supination that appears at birth. If it is detected before the child is three years old, the deformity can be successfully treated conservatively; if it is detected when the child is between three and six years old, it can be treated by plantar medial release. If the deformity is observed later, it is usually stiffer and nonreducible. The lateral column of the foot (calcaneus and cuboid) grows faster than the medial column (talus, navicular, and cuneiform), so the lateral column is longer than the medial. The aim of this video is to show the treatment of neglected congenital equinovarus by plantar medial release in conjunction with cuboid osteotomy in a six-year-old patient. In neglected congenital equinovarus in patients older than six years, the posterior and medial tendons and capsules are retracted. The correction consists in lengthening the medial and posterior tendons associated with the talonavicular capsulotomy. The surgeon uses an oscillating saw to perform the osteotomy of the cuboid bone on the lateral aspect, removing a small wedge with the base on the superolateral aspect. The wedge osteotomy of the cuboid bone will lead to the shortening of the lateral column. This process permits the complete reduction of the varus and the adduction deformity of the foot. Combining plantar medial release with cuboid osteotomy is a good technique to correct the deformity and relieve stiffness of the joints. Young patients can regain the neutral position of the foot so they can wear shoes, stand up, and walk correctly.

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