Supramalleolar wedge osteotomy: a method of correcting fixed equinus and associated deformities in children

Patients with fixed equinus and associated angular and rotational deformities, who have had multiple previous surgeries, present a significant challenge to the orthopaedic surgeon. We chose to correct these deformities with supramalleolar extension wedge osteotomies in 21 feet in 13 patients between 1991 and 2002. The median age at presentation was 11 years (range: 2-17 years). An average correction of 20° of extension (range: 10-33°) was required to achieve a plantigrade foot. Fourteen of 20 feet (70%) remained plantigrade at a mean follow-up of 6 years. Unlike traditional procedures such as triple arthrodesis and talectomy, this technique preserves preoperative mobility, avoids shortening of the foot, and restores a plantigrade and functional attitude.