Hindfoot valgus after posteromedial soft-tissue release for congenital club foot

Among 35 congenital club feet (talipes equinovarus), treated following the surgical technique described by Codivilla (13 feet) and by Turco (22 feet), 11 had serious secondary valgus of the hindfoot, which gave the foot an appearance similar to a flat foot. Valgus of the hindfoot is the result of a tilting of the talus at the ankle joint. This is caused by a failure of the medial active stabilization due to excessive lengthening or complete section of the Posterior Tibial tendon. This failure, in its turn, produces a secondary, progressive subsidence of the other medial passive structures, with subsequent valgus deviation of the hindfoot. The deformity has been corrected by an extra-articular talo-calcaneal arthrodesis, or by a varus osteotomy of the calcaneous in order to restore a normal load distribution on the whole articular surface of the ankle joint.