Talo-calcaneal osteotomy and soft tissue procedures in the treatment of clubfeet. I. Indications, principles and technique.

By simultaneous arthrography of the talocrural and talonavicular joints it is possible to demonstrate and measure the most important skeletal deformities in clubfoot. In this way it has been possible to establish the indications for alternative forms of treatment with a greater degree of precision. Most of our refractory or recurrent clubfeet have been treated successfully by various soft tissue procedures. In cases with severe talar deformity, however, these procedures have been complemented by correction osteotomy through the talar neck and calcaneus. The aim is to create muscle balance by soft tissue procedures and to correct pronounced skeletal deformities by osteotomy. This treatment plan has been used in about 50 of our clubfoot cases. The principles, objectives and indications of the surgical therapy are discussed in this article. The operative technique, as it has been developed with increasing experience, is described, and if careful attention is paid to all details the risk of complications is small and the correction is generally satisfactory. It must be emphasized that correction osteotomy is only a part of an overall treatment plan and that this operation is only indicated in a minority of clubfoot cases.