Achilles tendon Z-plasty with rollover tensor fascia lata graft for correction of equinus foot deformity

Equinus deformity is a condition in which dorsiflexion movement of the ankle joint is limited or decreased. Equinus deformity arises due to contracture/shortening/tightening in achilles tendon or soleus muscles or gastrocnemius muscle. The lengthening procedure of the achilles tendon can be done by various techniques such as the open or percutaneous method and Z-plasty versus sliding technique. Here we reported a case of post-traumatic equinus deformity of the right foot. The patient’s dorsiflexion movement was restricted. In this case, the patient was operated for open Z-plasty of the achilles tendon with rollover tensor fascia lata graft for lengthening of the contracted achilles tendon. The patient was discharged on the third postoperative day uneventfully. After 7 months of follow-up, the patient was walking normally without limping with the full range of motion at the right ankle joint as similar to his left ankle joint.

What is the optimal treatment for equinus deformity in walking-age children with clubfoot? A systematic review

Equinus contracture is the most common deformity at clubfoot relapse and causes pain and functional limitation. It presents a challenge to the orthopaedic surgeon throughout childhood. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were: (i) original articles, (ii) investigating management of relapsed idiopathic clubfoot, (iii) with at least a partial study population of primarily equinus deformity, and (iv) a paediatric study population of independent walking age. Nine studies were included with a total of 163 patients (207 feet). Studies presented five management paradigms: gastrocnemius-soleus complex release, extensive posterior soft tissue and joint release, anterior distal tibial hemi-epiphysiodesis, distal tibial osteotomy, and circular frame distraction. All approaches reported success in at least one of our selected outcome domains: plantigrade status, range of motion, clinical outcome scores, functional status, radiographic outcomes, patient-reported outcomes, and complications. Younger children tend to be managed with soft tissue release while older children tend to require more extensive bone/joint procedures. Relapse in surgically treated feet is harder to treat. Comparison across treatment approaches is limited by the small size and low evidence level of the literature, as well as a lack of consistent outcome reporting. It is therefore not possible to recommend any one treatment option in any age group. This review highlights the need for a validated core outcome set to enable high-quality research into the management of equinus deformity. Cite this article: EFORT Open Rev 2021;6:354-363. DOI: 10.1302/2058-5241.6.200110

Talo-calcaneal smile osteotomy as a treatment of rigid residual equinus deformity

Foot deformities are usually complex. Equinus deformity can be a residual foot deformity element or isolated. A rigid type is the most difficult for treatment. The aim of work is the treatment of rigid equinus deformity by a minimally invasive technique using Ilizarov fixator to restore plantigrade foot and to prevent further recurrence. 17 feet in 14 patients with stiff ankles and rigid equinus after failed surgical correction of club feet, with mean age 6.6 years (4 to 10 years), all treated by smile talocalcaneal osteotomy and Ilizarov ring fixator with a mean follow up 20.9 months (5 to 30 months). 5 feet (29.9%) had excellent results, 8 (47.1%) had good results, 1(5.9%) had a fair result and 3 feet (17.6%) had poor results and underwent revision surgery. In conclusion, our technique Talo-calcaneal smile osteotomy based on distraction osteogenesis method appears to provide similar or better results compared to other literature results without discrimination of foot size, provide some range of motion and plantigrade foot. Keywords: Clubfoot- equinus- rigid -deformity, Ilizarov- Smile osteotomy.

Modified Extended External Fixator Frame for Leg Elevation in Trauma

Lower extremity trauma is very often managed by applying an external fixator to stabilize the fracture site. These limbs very frequently require multiple surgeries, which predisposes them to problems like heel pressure sore, equinus deformity and limb edema. These complications prolong the healing time and create obstacles in rehabilitation. Our aim was to modify the usual uniplanar external fixator in such a way that it is able to provide stable limb elevation and also keep the leg and the foot in such a position, so as to avoid the above-mentioned complications. We used our frame in 10 patients and none of our patients developed heel ulceration or equinus deformity. We found that the frame enables easier daily examination of the wound and improves patient comfort during dressing changes.