I hava a 25 y.o. patient with bilateral lower limb palsy, 2 years post intensive care hospitalisation due to sever toxic shock (the exact reason is unknown). He presented pes equinus on the left, that was once treated with gastroc recession with early recurrance. He now presents stiff equinus, silverskjold (-) with the sign of motion only from tibialis posterior muscle. The remaining muscles appear to be affected by palsy. Other foot seems to have similar muscle function (only TP), but with foot plantigrade
What treatment can be used? I find it hard to get clear answer in the literature.
1. Achilles tendon lenghtening alone?
2. Achilles tendon lenghtening and wide joint release?
3. Tibiotalar joint arthrodesis with necessary release and Achilles lenghtening?
Any other?
Good morning. Have you thought about doing an Achilles tendon lenghtening and a tensioning of the anterior tibial tendon? If painful articular deformities of the hindfoot are present, selective arthrodesis can be performed. Are present other deformities as varus or supination of the foot?
Thank you for the answer! There are no other deformities nor arthritic changes (yet). I am worried that soft tissue correction will be just temporary as there is no function of both in flexors as extensors (apart from TP). Because he had one procedure done in calf that resulted in early recurrance I would like to try something with durable effect. Although, the soft tissue procedure will not be as invasive as arthrodesis so maybe we can give it a try - good point.
I understood your crucial points. I think should be a good idea an open surgery of achille’s tendon lengthening. He is a young patient, it is better to wait for an invasive fusion. Let us know about it.
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