Medial Plantar Release in Nonreducible Congenital Equinovarus Foot

The idiopathic congenital clubfoot, also known as equinovarus deformity or talipes equinovarus, is considered since now a deformity difficult to treat. Treatment of clubfoot starts at birth: depending on the stiffness of the deformity, gradual manipulations are performed, then plastercast and frames are applied. Only in some cases the surgical treatment is required. Some feet are extremely rigid and very little changes are visible after manipulation; these are usually smaller, stubby feet. If a clubfoot is not treated, at the age of walk, the foot stances only on its lateral aspect. The effect of weightbearing on a clubfoot worsen the varus and supination deformities, making the walk unstable and painful. The aim of this video is to show step by step the surgical treatment of a non reducible idiopathic equinovarus deformity between 2 and 6 years of age, operated by medial plantar release. The surgical procedure consisted in lengthening of the medial tendons of the foot; capsulotomy of the talo-navicular joint, repositioning the navicular bone on the talar head, and capsulotomy of the naviculo-cuneiform joints in order to reduce the varus deformity; and finally Achilles tendon lenghtening. Medial plantar release is still an actual surgical technique, but its indication is reserved for those feet in which the conservative treatment failed, or when the child is observed after walking age with a non reducible deformity, in which, otherwise, conservative treatment should be continued for a long period.