Electronic Letters to:

Children's Orthopaedics: O. Lahoti and S. Bajaj Is there a role for lengthening flexor hallucis and flexor digitorum longus tendons in surgery for club foot?: A PRELIMINARY REPORT J Bone Joint Surg Br 2008; 90-B: 801-802 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

Step by step surgical treatment of club foot deformity - probably the best treatment !

Zoran S Vukasinovic, Cedomir Vucetic, Goran Cobeljic, Zorica Zivkovic, Ismet Gavrankapetanovic, Jenel Marian Patrascu, Dusko Spasovski   (19 June 2008)

Step by step surgical treatment of club foot deformity - probably the best treatment ! 19 June 2008
Zoran S Vukasinovic, Professor of Orthopaedic Surgery Institute of Orthopaedic Surgery, Cedomir Vucetic, Goran Cobeljic, Zorica Zivkovic, Ismet Gavrankapetanovic, Jenel Marian Patrascu, Dusko Spasovski Send letter to journal: Re: Step by step surgical treatment of club foot deformity - probably the best treatment ! zvukasin{at}beotel.net Zoran S Vukasinovic, et al.	Sir, We read this paper with great interest. In the last forty years we have treated more than two thousand children with club foot deformity and we developed our own treatment. We agree that most cases respond well to non-operative treatment, especially if they are seen in the first three months of life. However, most patients present late with established deformities which frequently need surgical treatment. Surgery is undertaken in a 'step by step' fashion: 1. Lengthening of tendo Achillis and ankle and subtalar joint capsulotomies in order to address the equinus component. 2. Dividing (rather than lengthening) the tendons of tibialis posterior, flexor hallucis longus and flexor digitorum longus; and medial capsulotomy of the talo-navicular, naviculo-cuneiform and cuneiform-first MT joints in order to address inversion of the foot. 3. Dividing the plantar fascia and calcaneal origin of flexor digitorum brevis muscle in order to address the cavus component. 4. Division of the adductor hallucis muscle in order to address the adduction component of the deformity.1-5 We found that all the steps mentioned above are necessary, and produce neither overcorrection nor functional impairment. The only thing to keep in mind is preservation of the deep portion of the deltoid ligament! Z.S. Vukanisovic, Professor of Orthopaedic Surgery, Head of Pediatric Orthopaedics Department, C. Vucetic, G. Cobeljic, Z. Zivkovic, I. Gavrankapetanovic, J.M. Patrascu, D. Spasovski, Institute of Orthopaedic Surgery “Banjica”, Belgrade, Serbia. 1. Bensahel H, Csukonyi Z, Desgrippes Y, Chaumien JP. Surgery in residual clubfoot: one-stage medioposterior release "à la carte". J Ped Orthop 1987;7:145-8. 2. Dimeglio A. Le pied bot. Montpellier: Sauramps Medical, 1985. 3. Kovacevic B, Vukasinovic Z, Djoric I. Le traitement chirurgical du pied adductus et du metatarsus varus. Rev Chir Orthop 1993;79(Suppl I):174. 4. Tachdjian MO. The Child's foot. Philadelphia: WB Saunders Company, 1985. 5. Turco VJ. Resistant congenital club foot--one-stage posteromedial release with internal fixation. A follow-up report of a fifteen-year experience. J Bone Joint Surg [Am] 1979;61-A:805-14.