Tarsometatarsal mobilization for resistant adduction of the fore part of the foot. A follow-up study.

Surgical release of the tarsometatarsal capsules and intermetatarsal ligaments to permit correction of the adduction deformity of the fore part of the foot in congenital club foot and congenital metatarsus adductus has been shown to be an effective procedure in those patients in whom conservative methods have failed to correct the deformity 1• J@is to be emphasized that most congenital metatarsus adductus deformities and the majority of club-foot deformities are quite satis factorily corrected through conservative techniques. However, there is the oc casional patient with a club foot who demonstrates resistance to corrections of the fore part of the foot. The hind part of the foot may be adequately corrected to neutral or beyond while the fore part remains in an adductus or an adductovarus position. In this event, further attempts to correct the fore part of the foot forcibly by manipulations and plaster application or even wedging plaster casts may lead to overcorrection of the hind part of the foot with resultant skew-foot deformity. After extensive experience with the medial release procedure for correction of resistant varus deformity in an uncorrected club foot, Heyman applied similar principles to the release of the adduction or adductovarus of the fore part of the foot in early 1945. Results were encouraging and soon led to the application of the same approach to those isolated instances of metatarsus adductus that had proved to be resistant to manipulation and plaster treatment or those that were first seen in the older child. At the time the procedure was first reported in 1958, twenty-nine feet in twenty patients had been operated on with twenty-five good or excellent results. We have continued using the procedure with gratifying results and recently have reviewed the experience with it at University Hospitals of Cleveland and Elyria Memorial Hospital. It is the purpose of this presentation to discuss further ob servations based on this larger series of patients.