- 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