- 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

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, September 9, 2011 12:19 pm