Twenty-three cases of claw foot with limited talocrural and subtalar
mobility were the result of muscle contracture of the leg after
tibial-shaft fracture. A roentgenographic study including arteriography was
performed. It was concluded that the typical short cavus foot is due to
fibrous contracture of the muscles in the deep posterior compartment caused
by vascular damage, swelling in the deep posterior compartment, or severe
muscle laceration. On physical examination the distance between the lateral
malleolus and the Achilles tendon was shortened in comparison with the
sound side in all cases. This was found to be caused by dorsiflexion in the
talocrural joint coincident with adduction in the mid-tarsal joint. The
angulation of the foot forced the patients to rotate the leg outward in
order to get the feet in parallel position for walking. This deformity
could be misinterpreted as an inward malrotation of the tibial fracture. In
severe cases a derotating three-dimensional wedge osteotomy of the distal
part of the tibia was performed with promising results.