Goldner Four Quadrant Approach

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- 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;