Equinovarus clubfoot deformity secondary to cerebral palsy, which is caused by a lesion in the immature brain, results from the spasticity of the medial flexors turning the foot into equinus, adduction, and supination. If the condition is not recognized or remains unmanaged for an extended period, the growing process and weight-bearing will worsen the deformity, which will become stiff. This video demonstrates neglected equinovarus neuromuscular clubfoot in a 9-year-old patient. While walking, ground contact is in the lateral part of the foot, and the heel remains non–weight-bearing. The lateral column of the patient’s foot, which is represented by the calcaneocuboid, became longer than the medial column, which is represented by the talonavicular-cuneiform. Adduction gradually transformed into varus, and the deformity became rigid and unreducible.

The surgical technique shown in this video, which is from the archive of University of Pisa, was originally recorded in 1989, and involves modified plantar release and lengthening of the cuneiform with a bone graft. A standard medial approach is used. The skin incision is made near the Achilles tendon, curving distal to the medial malleolus and up to the first metatarsal. The posterior tibialis tendon is isolated and lengthened via Z-plasty. The talonavicular and naviculocuneiform joints are isolated and opened. Varus adduction is corrected. The retracted flexor digitorum and flexor hallucis tendons are lengthened via Z-plasty. An osteotomy of the cuneiform is performed, and a graft is inserted. Finally, the Achilles tendon is lengthened. Postoperative management consisted of 4 weeks of non-weight-bearing in a plaster cast followed by 4 weeks of weight-bearing in a plaster cast. Clinical and radiographic results demonstrate excellent correction of the deformity, with a plantigrade foot and the ability to bear weight. Modified posteromedial release and osteotomy of the medial cuneiform is a treatment option for the management of severe neglected equinovarus neuromuscular clubfoot.