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Preoperative Patient Care
Operative Techniques

Preoperative Plan


Radiographic templating


Execute a surgical walkthrough

  • describe steps of the procedure to the attending prior to the start of the case
  • describe potential complications and steps to avoid them

Room Preparation


Surgical instrumentation

  • casting materials
  • #6900 beaver plade


Room setup and equipment

  • OR table


Patient positioning

  • supine

Cavus Deformity Correction


Supinate the pronated foot


Elevate the first metatarsal


Place a well molded plaster cast with the forefoot supinated and a mold under the first metatarsal

  • this will maintain all the metatarsal heads in a row

Forefoot Adductus and Hindroot Varus Correction


Manipulate the forefoot

  • abduct the forefoot against counterpressure on the head of the talus
  • make sure the counterpressure is not on the fibula or the calcaneocuboid joint
  • this will correct the metatarsus adductus by reduction of the metatarsals and the navicular on the head of the talus and the cuboid on the calcaneus
  • with further casting the calcaneus will begin to evert and abduct under the talus
  • the hindfoot will then begin to convert from varus to neutral or valgus
  • it is critical to perform abduction with the foot in with the forefoot in supination and the foot in equinus so that the calcaneus can evert and abduct underneath the talus


Perform serial maniulations and casting

  • perform weekly manipulations and castings with the forefoot in supination and with the foot in equinus until full correction of forefoot adduction and hindfoot varus is obtained

Equinus Correction


Prepare for the tenotomy

  • prepare the area with Betadine prep
  • if performing in the office, place topical anesthetic to the area of the tenotomy 45 minutes before the procedure


Position the extremity

  • have an assistant hold the knee
  • position the foot to avoid excessive dorsiflexion
  • be aware of the location of the medial neurovascular bundle and remember the elevated calcaneal pitch


Perform a heel cord tenotomy

  • perform the tenotomy about 1.5 cm above the palpable tuberosity of the calcaneus
  • insert a #6900 beaver blade or # 11 blade medial to the tendon edge
  • rotate the blade laterally so that is lies partially anterior to the Achilles tendon
  • use a the contralateral finger to push the Achilles tendon against the blade to complete the tenotomy


Confirm that complete tenotomy has been performed

  • complete tenotomy is confirmed when there is an audible pop and there is an increase in dorsiflexion of approximately 20 degrees

Casting of the Tenotomy


Prepare the surgical site for casting


Place the cast

  • place a well molded plaster cast over a sterile cotton roll over the tenotomy site
  • apply the cast with maximum dorsiflexion and abduction of the foot
  • place mold over talar head for counter pressure
Postoperative Patient Care
Private Note

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