[Surgical management of talipes equinovarus as sequelae of a compartment and/or postischemic syndrome of the deep flexor compartment of the lower leg]. / Zur chirurgischen Behandlung des Pes equinovarus als Folge eines Kompartment- und/oder Postischämiesyndroms der tiefen Flexorenloge des Unterschenkels.

Cases of posttraumatic pes equinovarus after compartment syndrome have become more frequent in the last 3 decades because limb-saving procedures like compartment splitting, vascular repair, and microvascular free flaps have become well established in trauma surgery, thus reducing early below knee amputations. But if the deep flexor compartment is not split completely or if the muscles are crushed by direct trauma severe necrosis and subsequent muscle contractures result in a very severe clubfoot deformity. Metatarsalgia of fifth, fourth, and third metatarsal head even in well-fitted orthopaedic shoes occurs as well as painful bunions and fatigue fractures of the fifth metatarsal. Infected ulcers below the fifth/fourth metatarsal bone in a numb plantar sole often require head resection because of osteomyelitis.From 1994 to 2007 a total of 24 patients with severe pes equinovarus after compartment and/or postischemic syndrome were treated operatively. Only in 5 cases was a triple, Chopart, or Lisfranc arthrodesis necessary; 19 cases however could be treated only by soft tissue procedures like tenolysis, tendon lengthening, medial release of the scarred flexor retinacula and contracted capsules of the posterior ankle, subtalar and talonavicular joint to reorientate all axes of the foot. By temporary K-wire transfixation (6 weeks), initial external tibiotarsal transfixation of the foot (10 days), and additional tendon transfer for active foot elevation excellent and good long-term (5 years) results are achievable.The results according to the McKay Score are not significantly different regarding the triple arthrodesis group versus the pure soft tissue release group. Nevertheless, saving joints in the latter group seems to be very important.