Role of plantar aponeurosis in the formation of cavus component in recurrent congenital equinocavovarus deformity


  • S.O. Khmyzov State Institution “Sytenko Institute of Spine and Joint Pathology of the National Academy of Medical Sciences of Ukraine”, Kharkiv, Ukraine
  • G.V. Kykosh State Institution “Sytenko Institute of Spine and Joint Pathology of the National Academy of Medical Sciences of Ukraine”, Kharkiv, Ukraine
  • M.Yu. Karpinsky State Institution “Sytenko Institute of Spine and Joint Pathology of the National Academy of Medical Sciences of Ukraine”, Kharkiv, Ukraine



congenital equinocavovarus deformity, plantar aponeurosis


Background. Congenital equinocavovarus deformity (CECVD) is the second most frequent among all congenital disorders of the musculoskeletal system in children, and one of the most common causes of childhood disability in Ukraine. The incidence of CECVD reaches 1–3 cases per 1,000 newborns (35–40 % of all foot deformities). According to some authors, plantar fasciotomy can improve the shape and function of support and walking in these patients. The purpose was to determine the role of plantar aponeurosis in the formation of the cavus component in cases of recurrent CECVD in children. Material and methods. Mathematical researches were carried out using the graph-analytical method. Results. To reduce the arch height when correcting pes cavus, it is necessary to increase significantly the length of the aponeurosis (up to 25 % of its initial length). To perform this task, a significant tensile force must be applied to the aponeurosis, the value of which depends on the magnitude of a decrease in the arch height. So, to reduce the arch height by 10 mm, it is necessary to lengthen the aponeurosis by 12 mm, for which a constant force of 932 N must be applied to it. To reduce the arch height by 20 mm, the magnitude of the tensile force applied to the aponeurosis must be increased to 1,438 N, which is almost impossible. Therefore, the presence of a shortened aponeurosis is a significant obstacle for the effective correction of pes cavus. Conclusions. Correction of pes cavus requires a significant decrease in the height of its longitudinal arch, which leads to a significant lengthening of the aponeurosis, up to 25 % of its initial length. To ensure an increase in the length of the aponeurosis, the presence of a significant constant tensile force that exceeds 1000 N is necessary. Plantar aponeurosis plays a direct role in supporting the longitudinal arch of the foot, and is one of the causes for the persistence of pes cavus in patients with recurrent CECVD, which does not respond to conservative treatment. To correct cavus foot, in the failure of conservative treatment, it is necessary to lengthen it by surgical intervention (intersection). The value of the angle of the longitudinal arch of the foot of 110° can be chosen as a criterion for choosing a decision in favor of preserving or resection of the aponeurosis.


Ponseti I.V., Smoley E.N. The classic: congenital club foot: the results of treatment (1963). Clin. Orthop. Relat. Res. 2009 May. 467(5). 1133-1145. Epub. 2009, Feb 14.

Pirani S. A reliable and valid method of assessing the amount of deformity in the congenital clubfoot. St. Louis, MO: Pediatric Orthopedic Society of North America, 2004.

Abdelgawad A.A., Lehman W.B., van Bosse H.J., Scher D.M., Sala D.A. Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up. J. Pediatr. Orthop. B. 2007 Mar. 16(2). 98-105.

Зацепин Т.С. Врожденная косолапость и ее лечение в детском возрасте. М.: Медицина, 1947. 292.

Штурм В.А. Тенолигаментокапсулотомия при лечении стойких форм врожденной косолапости у детей. Вестник хирургии. 1951. № 2. 49-52.

Simons G.W. Complete subtalar release in club feet. Part II — Comparison with less extensive procedures. Journal of Bone and Joint Surgery. American Volume. 1985. 67(7). 1056-1065.

Thompson G.H., Richardson A.B., Westin G.W. Surgical management of resistant congenital talipes equinovarus deformities. Journal of Bone and Joint Surgery. Amer. Vol. 1982. 64(5). 562-565.

Ponseti I.V., Smoley E.N. Congenital clubfoot: The results of treatment. J. Bone Joint Surg. Am. 1963. 45(2). 261-275.

Kuo K.N., Smith P.A. Correcting residual deformity following clubfoot releases. Clin. Orthop. Relat. Res. 2009. 467. 1326-1333.

Mohammad Hallaj-Moghaddam et al. Ponseti Casting for Severe Club Foot Deformity: Are Clinical Outcomes Promising? Advances in Orthopedics. Vol. 2015. Article ID 821690. 5 p.

Suhodolčan L. et al. Treatment of the idiopathic and complex congenital talipes equinovarus with Ponseti method. Slov. Med. Jour. [Internet]. 19 Oct 2015 [cited 25 Oct 2018]. 84(10).

Bocahut N. et al. Medial to posterior release procedure after failure of functional treatment in clubfoot: a prospective study. J. Child Orthop. 2016 Apr. 10(2). 109-117.

Детская рентгенология: Учебное пособие. Под ред. проф. И.А. Переслегина. М.: Медицина, 1976. 264 с.

Алимханова Р.С., Карпинский М.Ю., Суббота И.А. Графоаналитическое моделирование тягового метода при патологии стоп у детей. Медицина и ... 2003. 1. 61-64.

Вырва О.Е., Горидова Л.Д., Мителева З.М., Карпинский М.Ю. Математическое обоснование функционального положения стопы при артродезе голеностопного сустава. Ортопедия, травматология и протезирование. 1997. 3. 58.

Демчук Р.М., Фіщенко В.О., Карпінська О.Д., Карпінський М.Ю. Навантаження відділів стопи під час ходьби після ушкодження кісточок гомілки. Biomedical and Biosocial Anthropology. 2012. 19. 214-216.

Березовский В.А., Колотилов Н.Н. Биофизические характеристики тканей человека: справочник. К.: Наукова думка, 1990. 224 с.





Original Researches