Complete tendon transfer and inverse Lambrinudi arthrodesis: preliminary results of a new technique for the treatment of paralytic pes calcaneus.
BACKGROUND
Paralytic pes calcaneus is commonly associated with myelomeningocele and continues to be one of the most difficult deformities to treat. The purpose of the present study is to describe and report the preliminary results of a new procedure to dynamically correct paralytic pes calcaneus.


METHODS
Since 2002, the senior surgeon operated on six patients with myelomeningocele and developed a new procedure to dynamically correct paralytic pes calcaneus. This new procedure combines a complete tendon transfer (tibialis anterior and posterior, peroneus brevis and longus, and extensor digitorum and hallucis longus) to the Achilles tendon and an additive triple arthrodesis. The extent of the calcaneus deformity was evaluated by measuring the talocalcaneal angle. The mean followup was 32 months.


RESULTS
Excellent results were achieved in five of the six patients with a mean age of 17.5 years. Using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scale, pain and function improved from an average of 41.6 preoperatively to 72.0 postoperatively. The deformity as assessed by the talocalcaneal angle, the calcaneal pitch, and the talometatarsal I angle improved after surgery significantly (p < 0.004). After 12 months, an additional surgery was required in two patients due to disabling drop-foot.


CONCLUSIONS
This new surgical technique to correct paralytic pes calcaneus including complete tendon transfer and triple arthrodesis is promising. Although this is a technically demanding procedure, it provides an excellent functional result without the residual complications associated with ankle arthrodesis.
Wenz
Wolfram
W
Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
Bruckner
Thomas
T
Akbar
Michael
M
D000293:Adolescent; D000328:Adult; D001174:Arthrodesis / Q000379:methods*; D002111:Calcaneus / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D005260:Female; D005531:Foot Deformities, Acquired / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008591:Meningomyelocele / Q000150:complications*; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D018709:Statistics, Nonparametric; D013709:Tendon Transfer / Q000379:methods*; D016896:Treatment Outcome