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1/6. Fibular nonunion and equinovarus deformity secondary to posterior tibial tendon incarceration in the syndesmosis: a case report after a bimalleolar fracture-dislocation.

    A 39-year-old woman sustained a grade II open bimalleolar fracture-dislocation of the left ankle. Six months after an ORIF of these fractures was performed, she presented with a nonunion of the distal fibula fracture and with a fixed hindfoot equinovarus and forefoot adduction deformity. At surgery for repair of the fibular nonunion, the posterior tibial tendon (PTT) was found to be entrapped in the posterior tibiotalar joint, with a portion of the tendon interposed between the tibia and the fibula in the area of the posterior syndesmosis. After extrication of the PTT, the hindfoot varus and forefoot adduction deformity were corrected. To our knowledge, this is the first case report in the English literature of a missed PTT syndesmotic entrapment that resulted in a fibular nonunion and in a fixed foot deformity after an open bimalleolar ankle fracture dislocation.
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2/6. Complex foot deformities associated with soft-tissue scarring in children.

    Two cases of deformities in scarred feet are presented. One case had an old, well healed forefoot amputation with severe equinovarus deformity, and the other had an equinus deformity following a burn injury 10 months prior. Both the cases were managed by primary release of the contracted joint capsules. The correction of the soft-tissue contractures was achieved by gradual distraction using the Ilizarov apparatus. The clinical presentation and surgical treatment of complex foot deformities, complicated by the presence of scar tissue, are presented. These cases illustrate the benefits of combining soft-tissue release with the ilizarov technique of distraction histogenesis in the treatment of complicated foot deformities associated with scarring in pediatric patients.
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3/6. Dislocation of the talonavicular joint: case report.

    Dislocation of the talonavicular joint is rare, caused by severe abduction or adduction of the forefoot. Proper reduction is necessary to avoid equinovarus deformity, ankylosis, or degenerative arthritis. A case of talonavicular dislocation with fracture of the head of the talus in a 52-year old woman is reported, with delayed treatment by open reduction using Kirschner wires and casting for 7 weeks. This patient is successfully employed as a waitress 2 years postinjury.
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4/6. Operation for calcaneus deformity after surgery for club foot.

    We describe three patients who developed gross calcaneus deformity following surgery for talipes equinovarus. One also had an associated valgus deformity and another had supination of the forefoot; all had intractable problems with footwear. Operation for transfer of the tibialis anterior to the heel, with correction of the associated deformities, was successful and improved both their gait and the shoe problems.
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5/6. stroke and its manifestations in the foot. A case report.

    CVA is a very common problem that can lead to lower extremity complications. Impairment in gait pattern occurs often due to spasticity and less frequently due to prolonged flaccidity. This problem is manifested by equinus, varus, equinovarus, and toe flexion deformities. Therefore, prevention or elimination of spasticity must be achieved. Various modalities have been used, both conservative and surgical. Nonsurgical interventions include range of motion and strengthening exercises, pharmacologic agents, local anesthetic and phenol motor point blocks, and the use of orthoses. Surgical intervention should be considered after conservative treatment has failed. The goal of treatment is to reduce the deforming force as a result of spasticity and to allow for almost normal function to be achieved. This includes tendon transfers, tendon lengthenings, tenotomies, and arthrodeses of small toe joints. Preoperatively, the extent and progression of spasticity must be determined because this may affect the rate of recurrence of the deformity following surgical correction. The combination of arthrodeses of the interphalangeal joints and flexor tendon release is the best option in the presence of a spastic deformity. arthrodesis provides for stability at the joint, whereas a flexor release eliminates the deforming force. Failure to address the plantar-flexor force of the long flexors can lead to instability at the fusion site. This may in turn lead to nonunion and recurrence of flexion contracture as shown in the case report in this article.
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6/6. Successful treatment of hereditary progressive dystonia--a case report.

    Hereditary progressive dystonia or Segawa disease is a very rare disease. diagnosis depends on typical clinical features with remarkably good response to levodopa and normal laboratory findings. Here, we report on a unique case of Segawa disease with a fixed equinovarus foot. The patient was a twenty one year old female with the typical clinical manifestations since eight years of age who became wheel-chair dependent at the age of fifteen. The dystonia responded well to levodopa except for the foot deformities. The foot deformities were successfully corrected by use of the Ilizarov apparatus and she ambulated freely at follow up. Since several similar foot deformities appeared in the early stage of a progressive neurological degenerative disease, the treatable Segawa disease should be added to the differential diagnosis when facing a patient with pes equinovarus.
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