SOFT-TISSUE RELEASE FOR THE TREATMENT OF FOOT DEFORMITY FOLLOWING ISCHEMIC CONTRACTURE OF THE LOWER-EXTREMITY

Sixty-three patients with rigid equinovarus contractures of the foot f ollowing ischemic episodes in the lower leg were treated at our instit ute from 1983 to 1994 by lengthening the Achilles tendon and the tendo n of the m. tibialis posterior, release of the tendons of the m. flexo r digitorum long us a nd the m. flexor hallucis longus and release of the dorsal capsule of the ankle joint. Patients with an equinus deform ity greater than 20 degrees, with an additional hind foot varus deform ity of more than 5 degrees and/or malrotation of the midfoot were not eligible for this procedure. The initial equinus deformity ranged from 7 degrees to 20 degrees (mean 14 degrees). The clinical and radiologi cal results of 41 patients were evaluated retrospectively with a minim um follow-up of 1 year (mean 3.4 years). The overall results were eval uated according to a modified sco re of Angus and Cowell. Results were good in 60.9%, fair in 29.3% and poor in 9.8%. The range of motion of the ankle joint and the subtalar and midtarsal joints could not be im proved. Postoperative complications were observed in 8 patients, one i ntra operative lesion of the posterior tibial artery occurred, one avu lsion fracture of the anterior tibial metaphysis and one compression s yndrome of the tibial nerve. One patient had an initially incomplete c orrection with a remaining equinus deformity of 10 degrees, and two re currences of the foot deformity after initially correct position were observed. Furthermore, two hematomas and two soft-tissue infections re quired surgical revision. These complications may have been due to the preoperatively scarred soft tissue at the medial aspect of the hind f oot and a residual postoperative soft-tissue defect after the correcti on of the foot deformity had been achieved. In conclusion, the techniq ue described is effective in correcting mild pes equinovarus deformiti es after ischemic episodes in the lower leg. If the pes equinus deform ity is greater than 20 degrees, corrective osteotomies of the hind foo t should be performed instead.