Surgical Treatment of Foot Deformities in Myelodysplasia

Lee, Duk Yong; Choi, In Ho; Chung, Chin Youb; Kang, Seung Baik

Abstract

We reviewed 43 feet in 23 patients who had myelodysplasia and underwent surgical treatment for foot deformities at the Seoul National University Children's Hospital from 1986 to 1991. There were 12 boys, and 11 girls. Eleven patients had myelomeningocele, whereas 11 patients had lipomyelomeningocele and 1 patient had occult spinal dysraphism. The mean age at operation was 7 years 1 month(range, 2 month-14 years). The affected neurological levels were below L1 or L2-2 patients, below L3 in 2 patients, below L4 in 12 patients, below L5 in 5 patients, and sacral in 2 patients. The average length of follow-up was 3 years(range, lyear-7years and 1 month). There was significant correlation between the types of foot deformity and the neurosegmental level as follows : 4(100%) feet of varus deformity in below L3, 13(61%) feet of varus deformity in below L4, 4(40%) feet of cavus deformity and 5(50%) feet of calcaneal deformity in below L5, and 4(100%) feet of cavus deformity in below sacral level. Equinovaurs, however, was observed irrespective of the neurosegmental level. Various kind of bony surgery (41 feet), soft tissue release(40 feet), and tendon transfer(36 feet) were performed to obtain the plantigrade foot. Satisfactory results were obtained in 30 of 43(70%) feet. Unsatisfactory results were due to recurrence(8 feet), overcorrection(3 feet), and incomplete correction(2 feet) of the foot deformity. Lipomeningocele, preoperative ankle valgus deformity and retethering of the nerve roots were high risk factors which were closely related to the recurrence of the foot deformity. To reduce the recurrence of foot deformity, we suggest that complete correction of the deformity, the maintenance of correction, and early detection of neurologic change due to retethering are mandatory.