Achilles tenodesis for calcaneus deformity in the myelodysplastic child

Calcaneus deformity in patients with neurologic disorders leads to gait disturbances, a high incidence of osteomyelitis, cellulitis, and skin breakdown, and a major problem in the fitting of shoes of orthoses. Correction of this deformity remains a difficult challenge for the orthopedic surgeon. Twelve tenodeses of the tendo Achillis to the fibula or tibia were performed in eight patients with myelodysplasia in an attempt to control calcaneus deformity. The average age of the patients at the time of surgery was 7.4 years (range, 3.1-13.5 years) with an average follow-up period of 6.3 years (range, two to 10.9 years). The clinical examination demonstrated definite improvement in the ability to brace, prevent skin breakdown, and improve gait in all but one patient who had progressive hindfoot valgus. Roentgenographically, there was improvement in the tibiocalcaneal angle in 67%, fibular station in 58%, talar tilt in 25%, and growth of the posterior aspect of the calcaneus in 58%.