Confirmation of arterial deficiencies in a limb with necrosis following clubfoot surgery

This study describes postoperative necrosis of the hallux and first ray in a child with clubfoot. Arteriography performed on this child's lower limbs demonstrated, in the operated leg, hypoplasia of both the anterior and post erior tibial arteries and failure of the dorsalis pedis artery to traverse the tarsus and complete the deep plantar arch. Previously, congenital vascu lar deficiency was suggested to predispose such operated limbs to necrosis. These findings confirm the association between vascular deficiency and nec rosis. In this present study, the metabolic demands of wound healing were s ufficient in a limb with vascular deficiency to cause localized distal hypo perfusion leading to cyanosis and necrosis of the hallux and medial foot.