Fibular shortening in clubfeet

Seventy-eight children (105 feet) operated on for congenital clubfoot with two different procedures - limited posteromedial-lateral release and complete subtalar release - were analysed. For all of them the age at operation ranged from 3 to 76 months (mean 17 months) and follow-up from 41 to 84 months (mean 58 months). The control group consisted of 42 opposite feet from the patients with a unilateral deformity. In all the feet operated on, a higher positioning of the fibula in relation to the talar dome was found. A correlation between the high positioning of the fibula and the strength of the plantar flexors was noted in children operated on by limited posteromedial-lateral release (the weaker the strength of the plantar flexors the higher the position of the fibula in the ankle). There was no correlation between the position of the fibula and the hindfoot valgus, the limited range of motion within the talo-calcaneo-navicular joint, and the talo-calcaneal angle in the anteroposterior view. In the same group, the difference in the distance between lateral malleolus and talar dome in the healthy and affected foot did not increase with age, but in the group operated on by complete subtalar release, there was a tendency for increasing shortening.