الفهرس 
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Abstract
Paralytic hindfoot valgus used to be treated at the level of the subtalar only. It can also occur at the level of the ankle where the subtalar fusion will not correct the deformity but even make it worse. The aim of this study was to determine the protocol of treatment of paralytic ankle valgus secondary to poliomyelitis.
Twenty two cases of ankle valgus secondary to poliomyelitis were analysed clinically and radiologically. Ankle valgus is characterized clinically by having the medial malleolus as the most prominent medial bony prominence. There is a triade of deformity in the weight bearing X-ray of the ankle which are fibular shortening, lower tibial epiphyseal wedging, and talar tilt.
The study tried to analyze the pattern of muscle paralysis that accompanies paralytic ankle valgus. Both tibialis posterior and anterior were found to be paralyzed in all cases. Triceps surae was paralyzed in most cases. But cases differed in their peroneal muscle activity as there are two patterns of presentation.
The first pattern with peroneal paralysis and the second had active peroneii with muscle imbalance between evertors and invertors. These patterns differ in both their pathogeneses and characteristics of deformity.
The first pattern was characterized by being earlier in onset of paralysis and presentation, more severe fibular shortening, and is usually associated with external tibial torsion, and usually corrected after treatment of ankle valgus alone.
While, the second pattern was characterized by later onset of paralysis and presentation, less severe fibular shortening, and all cases had combined ankle and subtalar valgus, and even cases with ankle valgus alone have previous subtalar fusion. ll is usually accompanied by calcaneal deformity but none had external tibial torsion. It almost needs a second stage subtalar fusion usually’ with tendon tansfer according to the muscle imbalance.
Sixteen cases were treated by supramalleolar osteotomy, four cases by fibulilr-Achilles tenodesis and three cases by Internal fixation for Fibular pseudarthrosis (one of them was followed• by supramalleolar osteotomy).
A new scheme for evaluation of the results was suggested, which can accurately evaluate both the clinical (pain, valgus, and patient satisfaction) and X-ray (talar tilt percentage of correction, fibular level, and lower tibial epiphyseal wedging gain).