Weinstein Lovell and Winters Pediatric Orthopaedics 7e

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CHAPTER 30  |  The Child with a Limb Deficiency

FIGURE 30-16.  The talus is completely removed by cutting through the talocalcaneal ligaments. A saw (or often only a knife) is used to fashion a portion of the calcaneus to fit under the articular surface of the tibia. First, a portion of the ante- rior calcaneus is removed. Next, the articular surface of the calcaneus is removed to expose cancellous bone (A) . Finally, enough of the distal tibia is resected to expose the bony nucleus of the distal epiphysis (B) . A rongeur is used to shape the calcaneus so that good bony contact is achieved between the calcaneus and the distal tibia. This is stabilized by a smooth Steinmann pin that passes through the heel pad and the calcaneus and into the tibia. The calcaneus must be pulled forward before fixing it to the tibia to avoid a posterior prominence that would interfere with prosthetic fitting and wearing.