Complications of the Grice-Green operation

A case presentation involving complications resulting from errors in surgical technique with the Grice-Green procedure is discussed in this report. The patient was treated 18 years after bilateral tendo achillis lengthenings and Grice-Green extra-articular subtalar arthrodeses with autogenous tibial bone grafts. The complications encountered were severe adductovarus deformity of the feet with multiple painful plantar callosities, in-toed gait with weightbearing on the lateral aspect of the feet, inversion ankle instability, and tripping over the feet. Deformity and symptoms were worse on the right foot. The patient required further surgery, consisting of bilateral calcaneal osteotomy, metatarsal neck osteotomies, excision of callosities and ostectomies for painful plantar metatarsal base lesions, tenotomy of the abductor hallucis and digital fusions. The original surgery was performed for idiopathic flatfeet. Despite the many different causes of flatfoot for which the Grice-Green procedure has been employed, most authors believe it should not be used for idiopathic flatfeet, and restrict its use to the original indication, that of paralytic pes valgus secondary to poliomyelitis. The reader should also realize that there are very long-term consequences to surgery on the pediatric patient.