Correction of equinus in clubfoot: the contribution of arthrography

The equinus deformity in clubfoot is twofold: talocrural and talocalcaneal. No study has been carried out on the link between these two elements and whether they are mutually dependent or independent. This has led to an unvarying operative strategy confined to opening the talocrural capsule and section of the talofibular ligament. To assess the extent to which these procedures are warranted, the authors performed perioperative talocrural arthrography, taking radiographs before and after each stage of operative treatment. In all cases, talocrural equinus seemed to disappear without the need for opening the talocrural capsule or sectioning the posterior talofibular ligament. Capsulotomy produced only an artificial, temporary increase in dorsiflexion due to posterior gaping between the talus and the tibia. The anatomy of the posterior talofibular ligament, moreover, makes it improbable that there is anything to be gained by sectioning it when congenital equinovarus clubfoot is being operatively reduced.