الفهرس 
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Abstract
This work aims to evaluate the role of open surgical procedures in the management of complex foot and ankle deformities of different aetiologies.
This study is analytic cross section study. It is combined retrospective and prospective study. The retrospective part (group I: 62 feet) includes the patients who were operated in the period between 2008- 2009. The prospective part (group II: 11 feet) includes the patients who were operated in 2010. All cases were operated in at Heidelberg University Hospital, Heidelberg, Germany.
All patients had complex foot deformity, aged more than 12 year, with minimum clinical follow up 2years and radiological follow up 1 year.
Preoperative planning was based on clinical and radiological assessments to define the type of deformity, its components, aetiology, as well as associated limb deformities. Assessment of the muscle power around the foot and ankle is important to choose the suitable tendon transfer.
Seventy-three patients, with different foot deformities (calcaneocavovarus (39.7%), equinocavocavus (26%), cavovarus (26%) and clubfoot (8.3%)) were operated. Most of deformities were neurogenic (76.7%). Other causes were recurrent clubfeet (5.5%), traumatic (4.1%) and idiopathic (13.7%).
All patients received combined bony and soft tissue procedures aiming to correct the deformity, stabilize the foot and prevent the recurrence of the deformity. This was achieved by Chopart’s joint fusion (82.2%), triple arthrodesis (4.1%), Lambrinudi arthrodesis (11%), and navicular excision with calcaneocuboid and talocuneiform fusion (2.7%). Forefoot correction was achieved by extension osteotomy of the base of the MT1 or fusion of the 1st tarsometatarsal joint. Modified Jones procedure was used for correction of clawing big toe deformity.
Soft tissue procedures inform of release of tight structures (plantar fascia release, capsulotomy), tendon transfer, tendon lengthening or tenotomy were needed to help the achievement of bony correction with the least bony resection and to restore the soft tissue balance around foot and ankle. Total split transfer of tibialis posterior tendon to tibialis anterior and peroneus brevis was the most commonly use transfer in our series (90.4%). Other tendon transfers included Hiroshima transfer (2.7%), transfer FDL to PB (2.7%) and transfer tibialis posterior tendon to tibialis anterior (1.4%).
from radiological assessment, all deformities were significantly corrected except the cases with clubfeet deformity which were treated only with Chopart’s joint fusion. It is thought to be due to the site of main deformity being in the triple joint complex rather than due to flexion of the 1st ray.
Postoperative assessment of group II patients showed significant increase in AOFAS score and decrease in FFI score. The average AOFAS score of all operated feet at the last follow up was 77.25 /100.
In spite of occurrence of some complications in our series, the patient’s satisfaction rate was 92%. 88% of our patients will accept to have the same operation they had.