RESULTS OF CLUBFOOT SURGERY IN MYELOMENIN GOCELE

Between 1974 and 1991, 100 equinovarus deformities in 65 patients with myelomeningocele have been primary operated at the authors clinic. Ai m of our treatment was a plantigrade position of the foot, to give the possibility of an orthetic supply. 75% of our patients reached this r esult after the first operation, 25% had to be operated once more. The incision was done in the way of Cincinnati. According to the level an d type of paralysis the operative treatment had to be adapted. We coul d reach good results of treatment in group 1 (thoracal to L2) with 64% of plantigrade feed as well as in group 3 (L5 to sacral) with 61%. Gr oup 2 (L4 to L5) was worse with 32%. Within all types of paralysis the re was a better result while doing a tenotomy. Paralysed muscles shoul d be cutted, innervated muscles should be extended to keep the functio n. Important is the reconstruction of a balance of the muscles. While you have a forefoot varus, a plentiful medial release is necessary. Af ter the operation a cast was given for 8 to 12 weeks, followed by spec ial shoes and nightly storage in stales. Corresponding to the treatmen t of idiopathic equinovarus deformity the beginning of therapy should be started after birth and should be completed while the child begins to verticalise.