11. ๏ Atrophy of the leg muscles, especially in the peroneal group.
๏ The number of fibres in the muscles is normal, but the fibres
are smaller in size.
๏ Tendo Achellis, tibialis posterior, flexor digitorum longus
(FDL), and flexor hallucis longus (FHL) are contracted.
๏ The calf is of a smaller size and remains so throughout life,
even following successful long-lasting correction of the feet
12. ๏ถTendon Sheaths:
Thickening frequently is present, especially of the tibialis posterior &
peroneal sheaths.
๏ถJoint Capsules:
Contractures of the posterior ankle capsule, subtalar capsule, &
talonavicular and calcaneo-cuboid joint capsules commonly are seen.
๏ถLigaments:
Contractures are seen in the calcaneo-fibular, talo-fibular, (ankle)
deltoid, long and short plantar, spring, and bifurcate ligaments.
๏ถFascia:
The plantar fascial contracture contributes to the cavus, as does
contracture of fascial planes in the foot.
13.
14. ๏ถThe order of correction is as follows :
1) Forefoot adduction.
2) Forefoot supination.
3) Equinus.
15. 1st Cast
๏จPrior to casting, the position of
the forefoot in relation to the
heel creates cavus of the foot.
The first cast application
addresses the foot deformity,
aligning the forefoot with
the hindfoot . In doing so,
the cavus is corrected ,
typically after one cast.
22. Soft Tissue Release:
๏ถAny Approach Should be able to Address the Release in all
Quadrants, Which are as Follows:
1) Plantar: Plantar Fascia, Abductor Hallucis, Flexor Digitorum Brevis, Long
& Short Plantar Ligaments
2) Medial: Medial Structures, Tendon Sheaths, Talonavicular & Subtalar
Release, Tibialis Posterior, FHL, and FDL Lengthening
3) Posterior: Ankle & Subtalar Capsulotomy, Especially Releasing Post
Talofibular & Tibiofibular Ligaments & the Calcaneofibular Ligaments
4) Lateral: Lateral Structures, Peroneal Sheath, Calcaneocuboid Joint, &
Completion of Talonavicular & Subtalar Release.
