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Jung, Park, Lee, Eom, and Chung: Analysis of Clinical and Radiographic Outcome of the Reconstructive Surgery for the Cavovarus Foot Deformity
Original Article

J Korean Foot Ankle Soc 2014;18(2):62-67.

Published online: 10 June 2014

DOI: https://doi.org/10.14193/jkfas.2014.18.2.62

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

Hong-Geun Jung, Jae-Yong Park*, Dong-Oh Lee, Joon-Sang Eom, Seung-Hee Chung

Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea

*Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea

Corresponding Author: Joon-Sang Eom Department of Orthopedic Surgery, KonKuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea Tel: 82-2-2030-7638, Fax: 82-2-2030-7369, E-mail: eoms1234@naver.com

Received 30 March 2014       Revised 23 April 2014       Accepted 30 April 2014

Copyright © 2014 Korean Foot and Ankle Society

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

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 27.5o to 46.7o. In radiographic measurements, calcaneal pitch angle improved from 19.1o to 15.8o, Meary angle from 13.0o to 9.3o, Hibb's angle from 44.3o to 37.0o, and tibio-calcaneal axis angle from varus 17.5o to varus 1.5o.

Conclusion

We achieved successful correction of cavovarus foot deformities by performing appropriate comprehensive reconstructive procedures with improved functional, radiographic measures and high patient satisfaction.

Keywords: Cavus foot, Deformity, Reconstruction

References

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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).
jkfas-18-62f1.tif
Figure 2.
Plain weight bearing lateral radiographs of a 34-year-old female with idiopathic cavovarus foot; preoperative (A) and postoperative (B).
jkfas-18-62f2.tif
Table 1.
Summary of Main Surgical Procedure for the Cavovarus Foot
Etiology of cavovarus foot Sex Age (yr) Bony procedure Soft tissue procedure Arthrodesis Others Total procedure count
Calcaeneal sliding osteotomy Midtarsal derotational osteotomy 1st MT/TMT DF osteotomy / arthrodesis PF release Achilles/ gastrocnemius lengthening Lateral ligament reconstruction Triple/ST arthrodesis Tendon transfer Other procedure
Idiopathic M 45 Triplanar   Osteotomy (+)         (+) 4
Idiopathic M 58 Biplanar   Osteotomy (+)   Modified Brostrom, deltoid release       5
Idiopathic F 33 Biplanar   Arthrodesis (+) Achilles         4
Idiopathic M 20 Biplanar   Osteotomy (+)   PL to PB transfer       4
Idiopathic F 34 Triplanar   Arthrodesis (+) Achilles PL to PB transfer     (+) 6
Idiopathic M 20 Biplanar   Osteotomy (+)   Modified Brostrom       4
Idiopathic M 40 Biplanar   Arthrodesis (+) Achilles PL to PB transfer       5
Poliomyelitis F 56       (+) Achilles Modified Brostrom     (+) 4
Poliomyelitis F 35     Osteotomy (+) Achilles   Triple     4
Poliomyelitis M 44 Biplanar (+)     Achilles Modified Chrisman-Snook     (+) 5
Poliomyelitis M 45 Biplanar (+)     Achilles Modified Chrisman-Snook, deltoid       5
                release        
Poliomyelitis F 42     Osteotomy   Achilles Modified Chrisman-Snook ST   (+) 5
CMT M 61 Biplanar   Osteotomy (+)   Modified Chrisman-Snook, PL to   (+)   6
                PB transfer        
CMT M 33 Triplanar     (+) Achilles     (+)   5
GB syndrome M 21 Biplanar       Triple hemisection Modified Chrisman-Snook   (+)   4
Hemiplegia M 43         Achilles     (+) (+) 3
Mean 　 　 　 　 　 　 　 　 　 　 　 4.6

CMT: Charcot-Marie-Tooth disease, GB: Guillain-Barre, M: male, F: female, MT: metatarsal, TMT: tarsometatarsal, DF: dorsiflexion, PF: plantar fascia, PL: peroneus longus, PB: peroneus brevis, ST: subtalar.

Table 2.
Summary of the Results of the Cavovarus Foot Patients
No. Etiology of cavovarus foot Sex Age (yr) Rt/Lt F/U period (mo) VAS AOFAS Patient satisfaction
Preop Final F/U Preop Final F/U
1 Idiopathic M 45 Lt 12 4 2 46 90 Satisfied
2 Idiopathic M 58 Lt 32 3 0 52 75 Satisfied
3 Idiopathic F 33 Lt 19 2 0 59 100 Satisfied
4 Idiopathic M 20 Lt 21 2 0 45 100 Very satisfied
5 Idiopathic F 34 Rt 15 2 0 64 100 Satisfied
6 Idiopathic M 20 Rt 15 3 2 75 90 Very satisfied
7 Idiopathic M 40 Lt 12 2 1 30 78 Very satisfied
8 Poliomyelitis F 56 Rt 45 5 1 47 87 Satisfied
9 Poliomyelitis F 35 Rt 35 4 2 36 73 Satisfied
10 Poliomyelitis M 44 Rt 25 7 0 34 100 Very satisfied
11 Poliomyelitis M 45 Lt 16 8 0 34 97 Very satisfied
12 Poliomyelitis F 42 Rt 12 9 0 61 96 Very satisfied
13 CMT M 61 Lt 49 2 0 60 90 Very satisfied
14 CMT M 33 Rt 20 3 0 49 83 Very satisfied
15 GB syndrome M 21 Rt 41 6 0 40 97 Very satisfied
16 Hemiplegia M 43 Rt 27 5 0 33 84 Very satisfied
Mean   　 　 　 24.8 4.2 0.5 47.8 90.0 　

CMT: Charcot-Marie-Tooth disease, GB: Guillain-Barre, M: male, F: female, Rt: right, Lt: left, F/U: follow-up, VAS: visual analogue scale pain score AOFAS: American Orthopaedic Foot and Ankle Society ankle-hind foot score, Preop: preoperative.

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