Yonsei Med J.  2014 May;55(3):766-772. 10.3349/ymj.2014.55.3.766.

Changes in Dynamic Pedobarography after Extensive Plantarmedial Release for Paralytic Pes Cavovarus

• Kwon YU
• Kim HW
• Hwang JH
• Park H
• Park HW
• Park KB

• KMID: 2068689
• DOI: http://doi.org/10.3349/ymj.2014.55.3.766

Abstract

PURPOSE
Plantarmedial release and first ray extension osteotomy are often combined to treat paralytic cavovarus foot deformity. The purpose of this study is to evaluate the effect of additional first ray extension osteotomy in terms of dynamic pedobarography.
MATERIALS AND METHODS
We reviewed findings of pre- and postoperative plain radiography and dynamic pedobarography for 25 patients in whom the flexibility of the hindfoot was confirmed by the Coleman block test. The results of treatment by extensive plantar medial release with first ray osteotomy (group I) were compared with the results of treatment by extensive plantar medial release alone (group II).
RESULTS
Plain radiographs obtained pre- and postoperatively showed no statistically significant improvement in each group. Only in group I, peak forces at the 1st metatarsal head, 2nd metatarsal head and medial calcaneus were increased after operation.
CONCLUSION
In paralytic hindfoot flexible cavovarus, extensive plantarmedial release with first ray osteotomy improve foot pressure distribution more than extensive plantarmedial release alone.

Keyword

Paralysis; pes cavus; osteotomy

MeSH Terms

Adolescent
Calcaneus/abnormalities/*radiography/surgery
Child
Child, Preschool
Female
Foot Deformities/*radiography/surgery
Humans
Male
Osteotomy
Retrospective Studies
Treatment Outcome

Figure

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  Fig. 1 Hindfoot flexibility was confirmed by the clinical and radiological Coleman block test.

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  Fig. 2 Ten year old boy with myelomeningocele has a cavovarus deformity. He underwent extensive plantarmedial release with Achilles tendon lengthening. Preoperative (A) and postoperative (B) standing lateral foot radiography was compared. After operation, Hibb's angle was increased from 124 degree to 126 degree and Meary angle was decreased from 21 degree to 15 degree.

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  Fig. 3 After operation, the peak forces in the forefoot area were increased in group I, but still decreased in group II.

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