The Importance of Plantar Muscles in Paralytic Varus Feet

The Results of Treatment by Neurectomy and Myotenotomy

¹ Durham, North Carolina
² Warm Springs, Georgia

1. Of forty-seven nearly flail varus feet treated by triple arthrodesis between 1940 and 1949, twenty-two (46 per cent) had recurrent talipes varus; in ten of these feet the deformity was of sufficient degree to warrant surgical repositioning of the foot. Eighty-one per cent of the recurrences could be attributed to intact functional plantar musculature, which was the most important deforming factor.

2. Treatment of this problem consists in ablation of the deforming factor. According to the authors' preliminary evaluation, the best results have been obtained by severance of the deep branch (muscular) of the lateral plantar nerve and by myotenotomy of the short toe flexors at the time of plantar fasciotomy and stabilization, the same plantar incision being used for all the procedures.

3. Similar treatment appears to be indicated for the child who is too young for stabilization but who has functional plantar musculature in an otherwise flail varus foot.

4. Neither neurectomy of the medial plantar nerve (or of its branches) alone nor myotenotomy of the short toe flexors and abductor hallucis alone is generally satisfactory in producing ablation of toe-flexor power in the paralytic varus foot. Neurectomy of the deep branch of the lateral plantar nerve alone has similarly been found inadequate.

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