J Korean Foot Ankle Soc.  2014 Jun;18(2):62-67. 10.14193/jkfas.2014.18.2.62.

Analysis of Clinical and Radiographic Outcome of the Reconstructive Surgery for the Cavovarus Foot Deformity

• Jung HG
• Park JY
• Lee DO
• Eom JS
• Chung SH

• KMID: 2181662
• DOI: http://doi.org/10.14193/jkfas.2014.18.2.62

Abstract

PURPOSE
Reconstructive surgeries for equinocavovarus foot deformities are quite variable, including hind-midfoot osteotomy or arthrodesis, soft tissue procedure, tendon transfers, etc. Comprehensive evaluation of the deformity and its etiology is mandatory for achievement of successful deformity correction. Few studies in this field have been reported. We report on the clinical and radiographic outcome of reconstruction for cavovarus foot deformities.
MATERIALS AND METHODS
The study is based on 16 feet with cavovarus foot deformities that underwent bony and soft tissue reconstructive surgery from 2004 to 2008. We evaluated the etiologies, varieties of surgical procedures performed, pain score, functional scores, and patient satisfaction and measured the radiographic parameters.
RESULTS
The average age at the time of surgery was 39.4 years old, with a male/female ratio of 9/4 and an average follow-up period of 23.9 months (range, 12~49 months). The etiologies of the cavovarus deformity were idiopathic 7 feet, residual poliomyelitis 5 feet, Charcot-Marie-Tooth disease 2 feet, and Guillain-Barre syndrome and hemiplegia due to cerebrovascular accident sequela 1 foot each. Lateral sliding calcaneal osteotomies were performed in 12 feet (75%), followed by Achilles tendon lengthening and plantar fascia release in 11 feet (69%), and first metatarsal dorsiflexion osteotomy/arthrodesis and tendon transfer in 10 feet (63%). Visual analogue scale pain score showed improvement, from an average of 4.2 to 0.5 points. American Orthopaedic Foot and Ankle Society ankle-hindfoot score showed significant improvement, from 47.8 to 90.0 points (p<0.05). All patients were satisfied. Ankle range of motion improved from 27.5degrees to 46.7degrees. In radiographic measurements, calcaneal pitch angle improved from 19.1degrees to 15.8degrees, Meary angle from 13.0degrees to 9.3degrees, Hibb's angle from 44.3degrees to 37.0degrees, and tibio-calcaneal axis angle from varus 17.5degrees to varus 1.5degrees.
CONCLUSION
We achieved successful correction of cavovarus foot deformities by performing appropriate comprehensive reconstructive procedures with improved functional, radiographic measures and high patient satisfaction.

Keyword

Cavus foot; Deformity; Reconstruction

MeSH Terms

Achilles Tendon
Ankle
Arthrodesis
Axis, Cervical Vertebra
Charcot-Marie-Tooth Disease
Congenital Abnormalities
Fascia
Follow-Up Studies
Foot
Foot Deformities*
Guillain-Barre Syndrome
Hemiplegia
Humans
Metatarsal Bones
Osteotomy
Patient Satisfaction
Poliomyelitis
Range of Motion, Articular
Stroke
Tendon Transfer

Figure

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  Figure 1. Plain weight bearing lateral radiograph shows the Meary angle (M), Hibb's angle (H), calcaneal pitch angle (C), and tibio-calcaneal axis angle (T).

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  Figure 2. Plain weight bearing lateral radiographs of a 34-year-old female with idiopathic cavovarus foot; preoperative (A) and postoperative (B).

Reference

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