Surgical management of resistant congenital talipes equinovarus deformities

We evaluated the results of surgery for resistant congenital talipes equinovarus deformity in 164 children (244 feet). No patient was followed for less than two years. They were divided into three groups for analysis, based on their treatment. Group 1 consisted of seventy-five children (112 feet) who had incomplete releases only; Group 2 consisted of twenty-three children (thirty-nine feet) who had had a failed incomplete release followed by a one-stage complete posteromedial plantar release, without internal fixation, and serial application of casts; and Group 3 consisted of sixty-six children (ninety-three feet) who had the complete posteromedial plantar release as the initial surgical procedure. Group 1 had 42 per cent, Group 2 had 79 per cent, and Group 3 had 86 per cent satisfactory (excellent or good) long-term results. The radiographic measurements that correlated best with the clinical results were the anteroposterior talocalcaneal overlap, the lateral talocalcaneal angle, and the positions of the navicular and calcaneus. The results in our series emphasize the complex interrelationship of the pathological anatomy and the need for complete simultaneous release of all components of the deformity.