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Two main causes of gastrocnemius contracture have been considered: 1) congenital deformities in pediatric patients, such as limb-length discrepancy, cerebral palsy, flatfoot, and clubfoot; and 2) secondary conditions such as immobilization for trauma or a nonfunctional limb. Talipes equinus deformity caused by fibrous gastrocnemius contracture after a direct muscle contusion is extremely rare. We describe 2 cases of talipes equinus deformity caused by fibrous gastrocnemius muscle contracture after a direct contusion in football players. Both of the players had a talipes equinus deformity with a severe restriction of ankle dorsiflexion, and a cord-like structure was observed at the proximal part of the lateral gastrocnemius head. Both patients' histological examinations revealed fibrous tendon-like tissue within the structure. After discission of the cord-like structures, the restriction of ankle dorsiflexion was completely resolved, and the patients were able to fully return to playing football without any discomfort in their calves.

Malignant hyperthermia (MH) is a potentially fatal disease triggered by general anaesthesia. Four cases of compartment syndrome complicating MH have been reported. We report here a case of transient talipes equinus deformity of bilateral lower limbs, a condition similar to compartment syndrome, following MH in a previously healthy pediatric patient. MRI revealed high intensity in the bilateral soleus muscles but not in the gastrocnemius muscles. We discuss the possible mechanisms of the deformity of the lower limbs after the MH crisis.

Summary The correction of neglected talipes equinus varus is a challenging problem. The dangers of soft tissue breakdown, and neurovascular damage, as well as unsatisfactory function, have widely been reported. A safe method with the use of a ring fixateur is presented, minimizing the risk of soft tissue or neurovascular damage. Prior to progressive correction by means of the ring fixateur, an anterolateral tarsectomy is performed. The correction is stabilized by a subtalar reorienting bone block arthrodesis and transfer of the anterior tibial tendon. A case of a 26-year-old patient with bilateral severe talipes equinus varus is reported.

Surgical Principles The gastrocnemius is elongated by multiple incisions of its strong anterior aponeurotic tendinous sheet, a structure which is usually ignored in standard textbooks of anatomy. Lengthening of the muscle is achieved by postoperative stretching exercises and by reflex inhibitive casting. The technique was first used by Baumann in 1980 and was presented with its results in 1988 at the annual meeting of the Swiss Orthopaedic Society.

We treated a patient with talipes equinus caused by peroneal nerve palsy.The patient was a 32 year-old male who was deaf and could not speak or hear. He had a right fibra fracture caused by a car accident in June 1990. He undertook osteosynthesis. Six months later the screw was removed and the patient subsequently experienced drop foot and plantalgia. He had rehabilitation treatment for 4 months but it had no effect. When he came to our hospital, dorsiflexion of his ankle was limited to -30 degrees. There was hypesthesia on the dorsum of his great and second toe.To treat his equinus contracture we performed Achilles tendon lengthening. ROM of ankle improved and now he has made a satisfactory recovery.

Rita Walford was born in Birmingham on 7 June 1915, the fourth of six children. Her eldest sister was struck down with meningitis at the age of 2 and that remained her mental age until her death at the age of 20, while a younger brother was born with bilateral talipes equinus. The corrective treatment required was beyond the family’s means, but their wonderful pre-NHS general practitioner persuaded the orthopaedic surgeon to waive his fees and the treatment was successful. From these early experiences came Rita’s burning ambition to study medicine, although the odds were very much stacked against her. Awarded a foundation scholarship in 1927 to King Edward VI High …

In the treatment of equinus deformity in cerebral palsy, dynamic deformities should be distinguished from fixed structural contractures. Spasticity and clonus can be relieved by selective neurectomy, whereas a fixed contracture requires lengthening of the musculotendinous mechanism. The role of the gastrocnemius and soleus portions of the triceps surae in equinus deformity should be determined, and the appropriate muscle selected as the target for surgical treatment. Postural deformities at the hip and knee must be carefully considered, and appropriate corrective procedures applied to them. Toe stance may be a compensatory mechanism secondary to postural deformities in the hip or knee and not a true equinus deformity. The amount of musculotendinous lengthening needed for correction determines the site and technique selected for the surgical treatment of contractural equinus deformity. The timing of the surgical treatment of equinus deformity is important. It should be avoided until after the child has reached the age of four years and, preferably, until after he has reached the age of eight years. If it is performed earlier in contractural equinus deformity, recurrence of deformity must be feared as the result of skeletal growth. Healthy controversy may well continue with reference to the surgical procedures preferred. Of most importance is the accumulation of adequate data concerning patients accurately classified as to their problems, treatment, and end results. When such information is available, more rewarding end results can be achieved.

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(REPORTED BY W. G. BAILEY.) This case appears to be cancer of the uterus. It is at least a fungous tumor, two and a half inches in diameter, filling the upper part of the vagina. It does not seem to have any adhesions to the walls of the vagina, but only to the cervix uteri. I will remove it cautiously, as the operation may be attended with some haemorrhage, which we will check if necessary. I will first use the ecraseur to remove the great body of the tumor, then I can use the curette. This growth covers nearly the entire cervix, so that I shall be obliged to remove its base by scraping. The body of the mass is now removed. The base of the growth is tough and does not yield to scraping very readily. We cannot, you know, cut very freely in this vicinity for fear of

Talipes equinus deformity of the foot, a common complication of hemophilia, often proves to be not amenable to correction by closed methods. It may be corrected by open operation, provided that postoperative hemorrhage is controlled by the use of lyophilized human fibrinogen rich in factor VIII. In the experience of the authors, illustrated by case histories, the preoperative use of this material is effective and safe. In non-resistant patients, infusion of fibrinogen resulted in predictable increases in the concentration of factor VIII in the plasma. Hepatitis and urticaria occurred in some cases.

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