Equinovarus is mainly divided into two types: congenital and acquired;Congenital Equinovarus caused by bad growth is mainly due to the Achilles tendon and shortening of the triceps surae, acquired the Equinovarus mainly because the ankle back extensor group, the outer most or complete loss of muscle strength, Triceps of the lower leg and most of the varus muscles strength is normal, lead to the Achilles tendon contracture, strephenopodia continuously, which in turn leads to the ankle, talonavicular joint, subtalar joints, with roll displacement of joints, foot ankle joints, ligaments and other soft tissue contracture of the joint capsule around, adhesion, secondary deformity.It is mainly caused by the following reasons, such as congenital musculoskeletal malformation, infection, osteomyelitis , congenital equinovarus failure in treatment, traumatic fracture and other reasons leading to the sequela of crus osteofascial compartment syndrome .Extensive scar on the ankle caused by burns , nervus peroneus communis injury , lumbosacral spina bifida and poliomyelitis sequela .Clinical manifestations are mainly: the talus pancake, the neck of talus shorter distortion, cartilage degeneration and the metapedes plantar flexion, varus and intorsion , navicular bone deformation dislocation after full high arch, supination deformity, propodeon adduction, the medial plantar and back skin, subcutaneous tissue, the fascia, tendon, articular capsule, blood vessels, nerves, such as soft tissue contracture, ankle lateral corresponding soft tissue hypoplasia, relaxation or destroy .
At present, the understanding of congenital equinovarus disease is relatively mature, and the therapeutic effect is remarkable.The case was a equinovarus caused by congenital lipomyelomeningocele. Lipomyelomeningocele (LMM) is neural tube defects (NTD), the disease is due at 18 ~ 28 d, premature epithelial ectoderm from neural ectoderm, mesenchymal cells into developing neural tube, the formation of fat affect the spinal cord, the fat through the catheter into the subcutaneous tissue, the disease often occurs in women, more than 30% of patients can be characterized by abnormal skin,Such as mass, fur sinus, vascular malformation, etc., all suggest that the patient may have abnormal neural tube development such as LMM.It can also be manifested as nerve damage, such as tetheredcord syndrome (TCS), such as defecation and urination dysfunction, lower limb motor sensation disorder, sexual dysfunction, etc. .Without timely intervention after the diagnosis of LMM, 90% of patients will develop irreversible progressive nerve damage .In many studies, through the inference of the natural history of this disease, it was believed that: most patients' symptoms gradually aggravated with time, including lower limb movement disorder, muscle weakness, equinovarus and high arch, and the symptoms gradually aggravated, and at this time, surgery was the only effective way to treat the symptoms at present;However, postoperative dysfunction of urine and feces, especially bladder function, cannot be improved .Long-term follow-up observation is needed after LMM operation to monitor the occurrence of LMM.LMM can occur months to years after surgery, with an incidence of 5% ~ 50%, manifested by gradual aggravation of original symptoms or new symptoms, such as pain, incontinence, sexual dysfunction, and weakness of both legs.After the postoperative stability of the patient's symptoms, new neurological symptoms or aggravation of the original symptoms should be evaluated for the presence of LMM.MRI examination is an important evidence to determine the presence or absence of LMM. Based on the presence or absence of lower spinal cord, syringomyelia, etc., the patient must be combined with clinical symptoms to make a correct judgment.
Equinovarus on the basis of the extent of the ankle joint stiffness is divided into soft and rigid, and the deformation of different age stages present different properties, Equinovarus deformity can press "qin SiHe equinovarus parting" description: Ⅰ degrees, with the outside of planta weight;Ⅱ degrees, use the front edge of the fourth and fifth metatarsal of weight;Ⅲ degrees, sufficient varus, internal rotation, toes pointing to the rear foot heart up, walking with foot dorsal weight.The case is rigid type Ⅱ degrees of deformity, needing delay correction, the correction to correct the strephenopodia inward turning talipes cavus, to correct the plantar flexion.
During the treatment, this case adhered to the principle of moderate weight-bearing walking exercise  and "two lines and three balances along the way"."All the way", that is, walking, walking in the treatment, walking in the treatment;The "two lines" are the "negative gravity line of the lower extremity" and the "joint line" of the hip, knee and ankle. The line and correction of other local malformations must finally meet the requirements of the recovery of the two lines of the lower extremity."Three-balance" is the "static balance and dynamic balance, the balance between the rigidity of fixed apparatus and the strength of bone healing, the balance between body and mind" in the process of limb reconstruction.By surgical treatment, malformations can be corrected, the shape of the ankle can be restored, and the affected foot plantar and painless weight-bearing walking can be made, so that the patients have high satisfaction .