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Inadequate Achilles tendon lengthening
18%
288/1575
Failure to correct hindfoot valgus
11%
174/1575
Failure to perform a posteromedial imbrication
7%
111/1575
Placement of the navicular in a dorsally subluxated position
56%
883/1575
Failure to perform a lateral column lengthening
107/1575
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Clubfoot, or congenital talipes equinovarus, consists of multiple foot deformities. There is cavus of the foot secondary to a plantarflexed first ray, as well as forefoot adductus, hindfoot varus and equinus. The Ponseti method is tried first, which requires a series of long leg casts to correct the deformity and almost always an Achilles tenotomy at the end of treatment. Schwend and Drennan provide a thorough description of possible causes as well as work up and treatment of children with cavus foot deformities. They state that cavus has been associated with clubfoot or residual clubfoot deformity in 22% of children and is typically associated with placing the tarsal navicular in a dorsally subluxated position at surgery. In general, soft tissue releases with tendon lengthening are favored in recalcitrant clubfoot. The complete subtalar release is described in detail by Simons, although ala carte approaches are more common. Wrong choices: 1. Would result in persistent equinus 2. The hindfoot is in a varus deformity 3. The posteromedial capsule is released, not imbricated 5. Lengthening of the lateral column in a clubfoot deformity would worsen the metatarsus adductus
3.3
(30)
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