CONGENITAL TALIPES EQUINOVARUS IN SPINA-BIFIDA - TREATMENT AND RESULTS

The results of the surgical treatment of clubfoot deformity in spina b ifida by radical posteromedial-lateral release (PMLR) are presented. I n all cases, the Cincinnati incision was used and the tendons excised, including the anterior tibial tendon. In 21 feet, a special K-wire wa s used to derotate the talus in the ankle mortise, The minimum follow- up was 2 years. The average age at surgery was 14 months, The overall results showed 63% good, 14% fair, and 23% poor results. In the 21 fee t in which the talus K-wire was used, 76% had a good result, 14% fair, and 10% poor. The results were also analyzed based on the motor level . In the thoracic/high lumbar level. 50% had a poor result. In the low lumbar and sacral level groups together, of 45 feet, five had a poor result. This study shows that a radical PMLR can produce an overall go od and fair result in 77% of the cases. The use of the K-wire to derot ate the talus led to an improvement in the result. The tendon excision leading to a flail foot corrects any residual muscle imbalance. The p oor results seen in the thoracic/high lumbar patients are likely to be related to the lack of weight bearing in view of their motor paralysi s.