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Journal of Bone and Joint Surgery, 1952;34:927-956.
© 1952 by The Journal of Bone and Joint Surgery, Inc

AN EXTRA-ARTICULAR ARTHRODESIS OF THE SUBASTRAGALAR JOINT FOR CORRECTION OF PARALYTIC FLAT FEET IN CHILDREN

DAVID S. GRICE M. D.1

1 Massachusetts Infantile Paralysis Clinics, Children's Hospital, Boston

Correction of pronated feet by arthrodesis of the subastragalar joint or by procedures adapted to limit eversion at the subastragalar joint has been accomplished by many surgeons. In this paper a method of obtaining fusion of the subastragalar joint with bone grafts is presented. The advantage of the method is that height is restored to the tarsus by the operation. Since the grafts are placed in the sinus tarsi, they are essentially extraarticlar in position and should interfere with growth in a minimal degree. The technique is simple and mechanical fixation of the joint is obtained with the grafts.

When the deformity is due to paralysis, the muscle imbalance must be corrected to prevent recurrence of the deformity. In cases of mild to moderate severity, it is advisable to transfer the peroneus longus to the base of the second metatarsal. The severe cases in which the astragalus is in marked equinus require tendon transference which provides support to the astragaloscaphoid region.

Although this operation has been used primarily in the correction of paralytic flat feet, it would seem to be of merit in the treatment of severely pronated feet in young children and the rocker deformities club-foot.


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