Goldner Four Quadrant Approach



- Discussion:
    - plantar, medial, posterior, and lateral, modifying the extent of release according to the severity of the deformity;
    - plantar quadrant includes the plantar fascia, the short toe flexors, and the long and short plantar ligaments.
    - medial quadrant involves talonavicular and subtalar release, lengthening of the posterior tibial tendon (often the flexor hallucis longus and 
         flexor digitorum longus are also addressed), and recession of the abductor hallucis origin;
    - it is rarely necessary to cut interosseous ligament of subtalar joint;
         - overcorrection of clubfoot is assoc w/ release of interosseous ligament, excessive lateral placement of navicular on talar head, and 
              overlengthening of tendon units (especially the Achilles tendon);
    - lengthening of the deltoid ligament may improve ankle range of motion but should be reserved for those familiar w/ this technique;
    - posterior quadrant entails ankle and subtalar capsulotomy, with special attention to the release of the posterior talofibular and
         calcaneofibular ligaments;
    - lateral approach involves calcaneocuboid capsulotomy, completion of talonavicular and subtalar release, and, often, sectioning of peroneal 
         tendon sheath;
    - foot is maintained most reliably in a reduced position by pinning talonavicular joint; many also pin tibiotalocalcaneal articulation;
    - postoperative casting is continued for 12 weeks, & pins are removed by six weeks



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

Last updated by Data Trace Staff on Wednesday, September 7, 2011 9:49 am