Pediatric foot surgery.

Muscle balance involves increasing or decreasing the relative strength of a muscle. It also includes redirection of muscle tendons to change their mechanical retrograde pull. Tendoachilles lengthening, gastrocnemius lengthening, anterior tendon teno-suspension, and the Kidner procedure exemplify this method. Muscle balancing is necessary whenever an imbalance exists. However, muscle balancing is usually only able to mildly effect joint position. It is important to eliminate a deforming muscle force and restore the balance of muscle power. Osteotomy to change internal bone shape is effective in pediatric foot surgery since malshape of the osseous structures is a major problem. The osteotomy is becoming a more important part of surgical treatment as a better understanding and recognition of the biomechanics of the foot and leg develops. The arthroerisis procedure for subtalar joint balance using implants is rapidly advancing. The concept that the subtalar joint can be balanced satisfactorily has been demonstrated. However, the lifetime implications are still unexplored. Joint stabilization with some motion still available at the subtalar is a leading concept in treating the foot. Fusion procedures are meant to realign malaligned joints and prevent further motion. They are applicable to pediatric foot surgery only in extreme conditions and in the growing foot at adolescence.