The examination and study of these seventy surgically corrected feet have been highly instructive, and of help in clarifying certain conceptions and misconceptions regarding the treatment and the care of this deformity.
First, has resulted the conclusion that soft-tissue operations, such as stripping of the os calcis, are of themselves not adequate except in cases of mild deformity in young patients. Likewise, tenotomies and capsulotomies for hammer toes of the severe or the moderately severe variety are disappointing, and the cavus and the concomitant deformities are apt to recur and to progress.
This study also indicates that most of the patients with milder deformity are not treated and watched over for a sufficient length of time. It is believed that better results could be obtained by longer immobilization in plaster, followed by proper shoeing, exercises, stretchings, and, when necessary, repetition of soft-tissue surgery before severe contractures have occurred.
It has demonstrated that adaptive ligamentous contractures and bone deformities occur rather early. In children of only eight or nine years, with slight to moderate deformity, these changes are often present to a degree which makes soft-tissue surgery inadequate.
The lesson has been convincingly brought home that full mobility and lateral motion of the non-paralyzed foot are of fundamental importance. Therefore, fusion of the mid-tarsal joints should be done only in the very severe deformities that cannot be controlled in any other way. Younger children seem to tolerate loss of lateral motion for a time, but later symptoms appear as a direct result of this loss of motion. Once the foot is rigid, it becomes increasingly difficult to employ conservative treatment for relief of pain and discomfort.
This study has emphasized what has been long known, but is sometimes forgotten even by competent surgeons, - namely, while most of these feet have the external appearance of true equinus deformity, the actual deformity is usually only a drop of the forefoot and requires no lengthening of the heel cord. Lengthening of a heel cord which is not short only adds to the original deformity. Cavus feet should never be operated upon until roentgenograms with the patient standing have been taken.
(C) 1940 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.