- Positioning of the Forefoot:
- if there is a tendency to err in one plane, err to place medial forefoot more platarward
thant the lateral aspect of the foot;
- forefoot should be in about 3-5 deg of valgus when ankle is in a neutral position;
- this valgus forefoot positioning is much more easily overcome by pt than varus forefoot
position (which is a more common error);
- w/
talipes equinovalgus, the medial longitudinal arch is depressed,
talar head is enlarged & plantarflexed, & forefoot is abducted;
- arch is restored by raising talar head & shifting sustentaculum tali medially beneath the talar neck and head;
-
talipes equinovarus, enlarged talar head blocks dorsiflexion & lies lateral to the midline axis of the foot;
- this is reduced to position slightly medial to midline axis, & it is performed thru subtalar
wedge based laterally, combined w/
midtarsal joint resection w/ wedge based laterally;
- forefoot
supination which may result w/ correction of hindfoot valgus deformity is controlled at
time of triple arthrodesis thru
midtarsal joint resection with a wedge based medially;
- at time of surgery, foot is aligned w/ ankle mortice, not w/ knee;
- any associated rotational or angular deformity in the remainder of extremity should be corrected by a separate procedure;
