Cuboid osteotomy associated with plantar medial release in severe untreated clubfoot

The idiopathic congenital clubfoot or equinovarus consists of a deformity of the foot in equinus, varus and supination, that appears at birth. If it is detected until 3 years of age, the deformity can be successfully treated conservatively; if it is detected until 6 years, it can be treated by plantar medial release. If the deformity is observed later, it is usually more stiff and non reducible: the lateral column of the foot (calcaneous and cuboid) grows faster than the medial column (talus, navicular and cuneiform). The aim of this video is to show the treatment of neglected congenital equinovarus by plantar medial release associated with cuboid osteotomy in a 6 Y/O patient. In neglected congenital equinovarus in patients from 6 years of age, the posterior and medial tendons and capsules are retracted; the correction consists in lengthening of medial and posterior tendons, associated with the talonavicular capsulotomy. On the lateral aspect, by an oscillating saw, the osteotomy of the cuboid bone is performed. A little wedge with the base on the supero-lateral aspect is removed. The wedge osteotomy of the cuboid bone will lead to the shortening of the lateral column; this process permits the complete reduction of the varus and the adduction deformity of the foot. In neglected congenital equinovarus in patients from 6 years of age, the posterior and medial tendons and capsules are retracted, and the lateral column is longer than the medial; the plantar medial release associated with cuboid osteotomy is a good technique to correct the deformity without stiffness of the joints. The young patient can regain the neutral position of the foot; so he can wear shoes, stand up and walk correctly.