[Corrective soft tissue interventions for equinovarus deformity. Foot deformities after tibial compartment syndrome]

Sixty-three patients with rigid equinovarus contractures of the foot following ischemic episodes in the lower leg were treated at our institute from 1983 to 1994 by lengthening the Achilles tendon and the tendon of the m.tibialis posterior, release of the tendons of the m.flexor digitorum longus and the m.flexor hallucis longus and release of the dorsal capsule of the ankle joint. Patients with an equinus deformity greater than 20 degrees, with an additional hind foot varus deformity of more than 5 degrees and/or malrotation of the midfoot were not eligible for this procedure. The initial equinus deformity ranged from 7 degrees to 20 degrees (mean 14 degrees). The clinical and radiological results of 41 patients were evaluated retrospectively with a minimum follow-up of 1 year (mean 3.4 years). The overall results were evaluated according to a modified score of Angus and Cowell. Results were good in 60.9%, fair in 29.3% and poor in 9.8%. The range of motion of the ankle joint and the subtalar and midtarsal joints could not be improved. Postoperative complications were observed in 8 patients, one intraoperative lesion of the posterior tibial artery occurred, one avulsion fracture of the anterior tibial metaphysis and one compression syndrome of the tibial nerve. One patient had an initially incomplete correction with a remaining equinus deformity of 10 degrees, and two recurrences of the foot deformity after initially correct position were observed. Furthermore, two hematomas and two soft-tissue infections required surgical revision. These complications may have been due to the preoperatively scarred soft tissue at the medial aspect of the hind foot and a residual postoperative soft-tissue defect after the correction of the foot deformity had been achieved. In conclusion, the technique described is effective in correcting mild pes equinovarus deformities after ischemic episodes in the lower leg. If the pes equinus deformity is greater than 20 degrees, corrective osteotomies of the hind foot should be performed instead.