Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table, with the affected limb elevated and prepared for a sterile field.

Anatomical surgical approach:  A longitudinal incision was made over the posterior aspect of the ankle to access the Achilles tendon for tenotomy. Subsequent incisions were made medially and plantarly to perform tenotomies of the posterior tibial tendon and plantar fascia, respectively. A dorsal approach was utilized for finger flexor tenotomy. For arthrodesis, a lateral approach to the ankle was employed to expose the tibiotalar joint, allowing for debridement and preparation of the joint surfaces before fixation with cannulated screws.

The surgeon noted that the extensive soft tissue release facilitated correction of the deformity. The use of an Ilizarov external fixator provided necessary stability post-arthrodesis, accommodating any residual soft tissue contractures and ensuring proper alignment during the healing process.

Postoperative protocol:   Postoperatively, the patient underwent walking training with full support using crutches. Weight-bearing was gradually introduced as tolerated under supervision.

Follow up:   Not specified.

Orthopaedic implants used:   Cannulated screws, Ilizarov external fixator.