- Discussion:
- in polio, paralytic equinovalgus deformity results from
paralysis of tibialis anterior and posterior, together w/ unopposed
action of peronei and triceps surae;
- os calcis is everted and is displaced laterally and posteriorly;
- sustentaculum tali can no longer function as calcaneal buttress for
talar head, which shifts medially and into equinus;
- hindfoot and forefoot equinovalgus deformity rapidly develop and with
growth the deformity becomes fixed;
- w/ triple arthrodesis (Grice) goal is restoration of medial
longitudinal arch;
- in ideal situation, valgus deformity is localized to sub-talar
joint & calcaneus can be manipulated into its normal position
beneath the talus;
- procedure is contraindicated unless the forefoot is sufficiently
mobile to be made plantigrade when the hindfoot is corrected;
- failure to heed this precaution results in the development of
painful callus over the fifth metatarsal head;
