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The authors report 46 cases of instability of the hindfoot involving the subtalar joint, with or without combined involvement of the tibiotalar ligaments, which were treated using Castaing's technique of ligament plasty between 1988 and 1999. Preoperatively, the patients complained of instability, recurrent sprains and pain. A tarsal sinus syndrome was present in 39%. Forty six patients underwent NMR examination which demonstrated capsuloligamentous lesions in every case. The results were evaluated using Kitaoka's score. With an average follow-up of 5.7 years after operation, instability was no more present in 80% and 63% were painfree. Clinical examination showed a reduction in the range of inversion of the hindfoot in 43%, with values between 50 and 70% of the contralateral foot, but without any significant clinical repercussion. Incipient osteoarthritis was noted on xrays in three patients. The overall results were very good in 82%, fair in 11% and poor in 7%. Eighty seven percent of the patients were satisfied with the result of the operation. The authors found a significant correlation between fair or poor results and a body mass index above 26 kg/m2 or constitutional laxity. Besides, results got worse as the time interval between the first sprain and the operative treatment increased. Comparison of these results with those of other techniques shows that they are essentially similar. Ligament plasty using Castaing's technique is a reliable operation but direct repair of ruptured ligaments at the subtalar joint should be preferred for primary treatment, leaving the possibility for secondary ligament plasty if necessary.

The authors have retrospectively studied 18 cases of tibiocalcaneal arthrodesis performed to treat a fixed equinovarus deformity of the foot in 13 adult patients. The operations were performed between 1981 and 1998; there were 9 neurologic and 9 post-traumatic deformities. The mean calcaneal varus deformity was 50 degrees and the mean equinus deformity was 75 degrees. The results were evaluated using Kitaoka's criteria. We noted one postoperative cutaneous necrosis, two nonunions, one of which was reoperated by bone freshening and osteotomy of the midfoot. All rearfeet were in neutral alignment and were stable. Shortening was on average 2.8 cm. Plantar support was achieved in 10 feet, with improved autonomy, walking capacity and footwear. Overall, there were 10 good, 2 fair and 1 poor result. In the group with neurologic deformities there were 4 good, 1 fair and 1 poor result. In the group with post-traumatic deformities, there were 6 good and one fair results. Other series published also showed satisfactory results comparable to or better than those obtained with triple arthrodesis, which generates severe stiffness of the rear- and midfoot, disturbing gait. Fixed equinovarus deformity of the foot in the adult is a good indication for tibiocalcaneal arthrodesis, allowing in the majority of cases to achieve stable and painless plantar support.

The authors reviewed 34 patients treated by tarsectomy for idiopathic pes cavus deformity between 1977 and 1996. Fifty two feet were treated surgically. All patients had undergone previous conservative treatment. The average age was 40 years. Podoscopic examination revealed 24 cavus feet stage 2, 28 cavus feet stage 3, adduction of the forefoot in 15 cases and an equinus deformity in 8 cases. On radiographic examination, Djian-Annonier's angle was 108 degrees on average. All patients were evaluated with a minimum ot two years follow-up, according to the evaluation system of the Massachusetts General Hospital. With an average follow-up of six years and six months, overall results were; 65.5% very good and good, 21% fair, 13.5% poor. The morphological correction was poor in 9 cases. Djian-Annonier's angle was 125 degrees on average. A number of cavus feet do not justify surgical treatment, because they are well tolerated, sometimes with orthopedic orthoses. Tarsectomy must be avoided in neurological conditions. We do not advise release of soft tissue or Dwyer's calcaneal osteotomy. In our opinion, the choice indication for anterior tarsectomy is the nonrigid cavus foot. It must be combined with lengthening of the Achilles tendon when a deficit of dorsiflexion of the foot persists following tarsectomy. According to their importance, associated deformations will be treated in the same operative session or not.

The authors report a series of Weil's cervicocapital metatarsal osteotomies which were performed to treat central metatarsalgias. The series included 70 central metatarsalgias treated by osteotomy of one to four metatarsals. There was an excess of length of one or several metatarsals in all cases; there were 30 metatarsophalangeal dislocations. The results were evaluated according to Kitaoka's criteria: 20 were quoted very good, 26 good, 9 fair and 3 poor. The osteotomy gave an overall improvement regarding pain and shoe fitting but the mobility of the MP joint was reduced in all cases. The results were satisfactory in cavus feet and in cases where the osteotomy was combined with correction of a hallux valgus. Weil's osteotomy allows accurate adjustment of the shortening and early weight-bearing. This is indicated in cases with excessive length of the central metatarsals and also in cases with metatarsophalangeal dislocations.