[A computer-assisted study of the surgical treatment of talipes equinovarus]

One-hundred-and-eleven club feet were treated surgically and followed up for more than three years. A computer analysis of the results, compared with the information contained in the operative notes, provided a better assessment of the effectiveness of each surgical procedure. Resection of capsular structures did not give better results than simple division. Posterior capsulotomy of the sub-taloid joint did not alter the separation between the talus and the calcaneus in lateral radiographs. Division of the plantar aponeurosis and lengthening of the long toe flexors seemed to diminish the frequency of secondary cavus deformity. Lengthening of the tibialis anterior improved the range of plantar-flexion of the ankle and reduced the occurrence of residual adduction of the forefoot and elevation of the first metatarsal. Finally, to avoid weakening of muscles, it proved to be vital to preserve the tendon sheaths and to avoid longitudinal tendon division followed by suture, which favours adhesions and tethering of tendons. The authors describe the details of the stages of surgical release. It is not a matter of a new approach to the treatment of club foot but a combination of detailed modifications aiming to produce a perfect final result.