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Surgical Anatomy and Impediments to Reduction of Clubfoot



- Surgical Anatomy of Clubfoot:
    - contractures of ankle, subtalar, talonavicular, & calcaneocuboid joints;
    - forepart of foot is adducted & hind part of the foot is in varus angulation;
    - talus:
          - lies in a position of equinus, & its head is palpable at sinus tarsi;
          - lies in externally rotation;
    - navicular is displaced medially, (cuboid is medial, but to lesser degree);
    - calcaneus is in equinus, varus, and is rotated internally
    - forefoot is adducted;
    - peroneal muscle atrophy;
    - soft tissue contractures:
          - plantar aponeurosis;
          - abductor hallucis;
          - FDB (causing a cavus deformity of foot);
          - contracture of Achilles
          - tibialis posterior;
          - long toe flexor tendons;
          - contractures of many of the ligaments in the foot (spring, bifurcate, deltoid, calcaneofibular, talofibular);
    - there may be deep medial foot crease that adds to the impression that longitudinal arch is in cavus.
    - intermalleolar axis is generally normal (no internal tibial torsion);
    - adduction of forefoot
    - medial rotation of tibia
    - pronounced medial angulation of head and neck of talus
    - inversion of Calcaneus
    - tightness of Tibionavicular ligament
    - tightness of  Ext. Digitorum Longus
    - tightness of  Tibialis Anterior
    - tightness of  Extensor Hallucis Longus

- Impediments to Reduction:
     - calcaneonavicular (spring ligament):
          - runs from sustenaculum tali to plantarmedial aspect of navicular;
     - tibionavicular ligament;
     - talo-navicular capsule (including superior, medial, and plantar parts);
     - posterior tibial tendon;
     - Master Knot of Henry:
          - fibrous slip that envelops the FHL and FDL tendons;
          - binds the plantar medial surface of the navicular;
     - calcaneal fibular ligament;
     - superior peroneal retinaculum;
     - posterior talocalcaneal capsule
     - posterior capsule of tibiotalar joint;
     - posterior talofibular ligament
     - tendo-Achilles