First Metatarsal Dorsal Close Wedge Osteotomy Combined with Medial Cuneiform Plantar Open Wedge Osteotomy for the Treatment of a Cavus Foot

Jung Ryul Kim; Soo Kyung Lee; Hyung Seok Lee

doi:10.4055/jkoa.2010.45.1.24

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Kim, Lee, and Lee: First Metatarsal Dorsal Close Wedge Osteotomy Combined with Medial Cuneiform Plantar Open Wedge Osteotomy for the Treatment of a Cavus Foot

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2010; 45(1): 24-30.

Published online: 28 February 2010

DOI: https://doi.org/10.4055/jkoa.2010.45.1.24

First Metatarsal Dorsal Close Wedge Osteotomy Combined with Medial Cuneiform Plantar Open Wedge Osteotomy for the Treatment of a Cavus Foot

Jung Ryul Kim, M.D., Ph.D., Soo Kyung Lee, M.D., Hyung Seok Lee, M.D.

Department of Orthopaedic Surgery, Chonbuk National University Medical School, Research Institute of Clinical Science, JeonJu, Korea.

Correspondence to: Jung Ryul Kim, M.D., Ph.D. Department of Orthopaedic Surgery, Chonbuk National University Medical School, 634-18, Geumam-dong, Dugjin-gu, Jeonju 561-712, Korea. TEL: +82-63-250-1767, FAX: +82-63-271-6538, jrkeem@chonbuk.ac.kr

Received 2 March 2009 Accepted 3 November 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We wanted to analyze the results of the 1st metatarsal dorsal close wedge osteotomy (MTDW) combined with medical cuneiform plantar open wedge (MCPOW) for treating forefoot deformity of a cavus foot.

Materials and Methods

We retrospectively analyzed 30 patients. Their mean age was 21.5 years (SD 10.6 years) and the average follow-up period was 2.3 years. Thirty-four cases of thirty patients were classified as group A, as classified by the 1st MTDW combined with the MCPOW, 16 feet (14 patients) were group B by the 1st MTDW or MCPOW, 12 feet (10 patients), and group C by triple arthrodesis, 6 feet (6 patients). We evaluated the ankle dorsiflexion, plantarflexion, heel alignment, and the Maryland foot score (MFS) preoperatively and the last follow-up, and we analyzed the radiologic Hibb, Meary, calcaneal pitch and tibiotalar angles.

Results

The ankle dorsiflexion (p=0.01), plantar flexion (p=0.03) and heel alignment (p=0.02) of group A were significantly improved more than that of groups B and C. The MFS of group A revealed better than group B and C (p=0.01). The Meary (p=0.01), Hibb (p=0.02) and calcaneal pitch angle (p=0.02) of group A were significantly improved more than that of groups B and C.

Conclusion

1st MTDW combined with MCPOW osteotomy that focuses at the apex of the deformity for correction of a cavus foot can obtain better clinical and radiological results than other surgical procedures.

Keywords: cavus, forefoot deformity, first metatarsal bone, medial cuneiform, dorsal wedge, plantar open wedge, osteotomy

Figures and Tables

Figure 1

Schematic drawing illustrating demonstrated the double osteotomy of forefoot. (A) Dorsal wedge osteotomy of the first metatarsal bone followed by obtaining a wedge shaped segmental bone. (B) Plantar osteotomy of the medial cuneiform followed by insertion a bone fragment.

Figure 2

Clinical photographs of patient with cavus deformity. Measurement of ankle angle on dorsiflexion, (A) and plantarflexion, (B) and heal alignment angle between hindfoot and ground, (C).

Figure 3

Histogram demonstrate mean Meary's angle at preoperative and follow-up period in three groups, and the angle of group A was best corrected than other groups (p=0.01).

Figure 4

Histogram demonstrate mean Hibb's angle at preoperative and follow-up period in three groups, and the angle of group A was best corrected than other groups (p=0.02).

Figure 5

Histogram demonstrate mean calcaneal pitch angle at preoperative and follow-up period in three groups, the angle of group A was best corrected than other groups (p=0.02).

Figure 6

(A) Clinical photographs of male patient with Charcot-Marie-Tooth disease. (B) Preoperative lateral radiograph demonstrating abnormal Meary's, Hibb's and calcaneal pitch angle. (C) Operative photograph showing double osteotomy of forefoot, and grafting segmental bone to plantar osteotomy site of the medial cuneiform. (D) Lateral radiograph made 2 years after osteotomy demonstrating correction of cavus deformity. (E) Photograph made 2 years after osteotomy showing that the ankle dorsiflexion, plantarflexion and healignment angle was improved than preoperative period.

Table 1

The Data of Patients Groups

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