Paralytic Valgus Deformity of the Ankle

Replacement of the Paralyzed Tibialis Posterior by the Peronaeus Longus

¹ Orthopaedic Department, Beilinson Hospital, Petach-Tiquah

Dynamic valgus deformity in small children, three to eight years old, is caused by poliomyelitis which paralyzes the invertor muscles, the evertor muscles remaining normal. This deformity cannot be corrected by apparatus. The procedure of tendon transfer, after careful evaluation of each patient, offers a solution to the problem of progressive deformity.

The transfer of tendons to substitute for paralyzed tibialis anterior muscles produced good results only in patients whose tibialis posterior muscles were normal. In most of these deformities the tibialis posterior was paralyzed, either singly or with paralysis of the tibialis anterior as well. Correction of the deformity was obtained by the substitution for the paralyzed tibialis posterior of a healthy muscle.

Replacement of this important muscle was achieved largely through use of the peronaeus longus or the flexor digitorum longus. Other muscles may also be used for this purpose, the flexor hallucis longus and the extensor hallucis longus being well suited for this transfer.

Twenty patients who have undergone this operation have been followed for two to two and one-half years. In fifteen of these patients, normal foot alignment resulted, and in three cases the deformity was improved. One overcorrection and one failure resulted. In six of the patients reconstruction of the tibialis posterior was combined with a tendon transfer for paralysis of the triceps surae.

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