Calcaneocuboid joint deformity in talipes equinovarus: an overview and update

The calcaneocuboid joint is significantly malaligned in some clubfeet. Calcaneocuboid deformity appears to be a combination of medial angulation of the calcaneocuboid joint with medial subluxation of the cuboid on the calcaneus. In moderate and severe cases, incomplete treatment of this deformity may result in rotary valgus of the hindfoot. One hundred consecutive cases of clubfeet requiring operative intervention, all treated at the Medical College of Wisconsin at Milwaukee between 1984 and 1988 were reviewed for incidence and treatment of calcaneocuboid abnormalities. A radiographic system of evaluation was devised, encompassing a normal grade of 0 and three grades of deformity based on the extent to which the midpoint of the cuboid had deviated from the longitudinal axis of the calcaneus or beyond the tangent defined by the edge of the calcaneus. The author's preferred surgical technique is described. Grade 1 deformity does not require operation; grade 2 deformity required extensive soft tissue release, and grade 3 deformity required a bone procedure in addition to extensive soft tissue release. The results demonstrated that partial release of the calcaneocuboid cuboid joint is never indicated because it may produce valgus of the hindfoot. Based on this sample, approximately 25% of all patients requiring operation will require calcaneocuboid release. Operation should be performed without placing undue pressure on the joints, which may produce late fusion; plantar release may be indicated as a means of reducing pressure on the joint surfaces. Operation before ossification of the cuboid should be avoided.