Pes Cavus Surgery

NewsBot · Dec 25, 2007

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The Akron Dome Midfoot Osteotomy as a Salvage Procedure for the Treatment of Rigid Pes Cavus: A Retrospective Review.
Weiner DS, Morscher M, Junko JT, Jacoby J, Weiner B.
J Pediatr Orthop. 2008 January/February;28(1):68-80.

OBJECTIVE:: In the early 1970s, the Akron dome osteotomy was developed as a salvage surgical option to manage rigid cavus deformity of the foot. This study represents an updated review of surgical cases between 1972 and 2001 constituting 89 patients representing 139 feet who were followed at least 2 years after the index operative procedure. Only cases achieving an unsatisfactory result followed less than 2 years were included.

STUDY DESIGN:: A retrospective review of cases (all operated by D.S.W.) was conducted by clinical examination and chart review of all 89 cases representing 139 feet.

RESULTS:: A satisfactory result was considered pain-free, at least 75% plantigrade foot in contact with the floor without abnormal symptomatic pressure areas, free of any significant deformity requiring surgical management. A satisfactory result was obtained in 106 (76%) and unsatisfactory result in 33 feet (24%). When separating the patients into those younger than 8 years and those older than 8 years, 67% of the patients younger than 8 years had a satisfactory result, and 82% older than 8 years had a satisfactory result. No significant complications were encountered. Because the surgery is located at the apex of the deformity in frontal, lateral, and plantar planes at the confluence of the longitudinal and transverse arches, multiplanar surgical correction was obtained in all cases at the time of the initial surgery. Currently, the most common causes of cavus deformity seen in our series were the sequelae of idiopathic talipes equinus varus clubfoot, congenital metatarsus varus, and assorted neuromuscular disorders, including Charcot-Marie-Tooth disease, cerebral palsy, and arthrogryposis.

CONCLUSIONS:: On the basis of this review, the Akron dome midfoot osteotomy is a very valuable salvage procedure in the management of the rigid cavus deformity in children.
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Admin2 · Dec 25, 2007

Related thread:
Mid Foot Arthroplasty

NewsBot · Mar 24, 2009

Osteotomies of the foot for cavus deformities in children.
Mubarak SJ, Van Valin SE.
J Pediatr Orthop. 2009 Apr-May;29(3):294-9.

BACKGROUND: The cavovarus foot has been defined as plantar flexion of the first ray. The usual cause is due to a muscle imbalance. The purpose of this study was to report our experience with selective, joint-sparing osteotomies of the foot that address each deformity in the cavovarus foot in a stepwise fashion. Most bony procedures for correction of cavus feet have centered on osteotomies across multiple joints or fusions.

METHODS: We report on stepwise osteotomies: (1) closing wedge to the first metatarsal, (2) opening plantar wedge of the medial cuneiform, (3) cuboid closing wedge, (4) and as needed second and third metatarsal osteotomies, calcaneal sliding osteotomies, and plantar fasciotomy and peroneus longus-to-brevis transfer. We measured all feet radiographically and clinically.

RESULTS: We studied 20 feet in 13 patients with multiple etiologies. Nearly all feet were graded good to excellent on our outcome scale. Correction in Meary and Hibb angles was observed. There were no significant complications.

CONCLUSIONS: By performing a double osteotomy on the first ray (cuneiform and metatarsal), the cavus can be nearly fully corrected. The cuboid osteotomy provides increased mobility of the forefoot. The sliding calcaneal osteotomy should be used to improve any residual hindfoot varus. We recommend transferring the peroneus longus to brevis to balance the paralytic foot. The cavus foot needs to be addressed at the apex, while sparing the midtarsal joints and avoiding fusion. This sequence of osteotomies addresses all of the components of a cavus foot.
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NewsBot · May 28, 2009

Anterior tarsectomy long-term results in adult pes cavus.
Naudi S, Dauplat G, Staquet V, Parent S, Mehdi N, Maynou C.
Orthop Traumatol Surg Res. 2009 May 19. [Epub ahead of print]

PURPOSE OF THE STUDY: Anterior tarsectomy for pes cavus in adults is designed to relieve pain and correct the deformity. The present study reports radiological and clinical results with anterior tarsectomy in 39 cases of pes cavus.

MATERIAL AND METHODS: The study concerned 39 cavus feet in 33 patients (22 males, 11 females; mean age: 31 years, range 16-49 years). Clinical outcome was assessed in terms of pain, function and motion, using the AOFAS classification. Radiological assessment (anteroposterior and lateral stress X-ray, views with Méary superficial wire-marking) measured the Djian angle, talometatarsal alignment, talar slope, calcaneal slope, calcaneal valgus, and osteoarthritis stage in adjacent joints.

RESULTS: Mean follow-up was 9.8 years (range, 1-25). Mean AOFAS score at follow-up was 69.2/100 points (range, 14-100). Pain decreased considerably in 75% of cases, and 68% of patients recovered normal activity. The foot was aligned correctly in 67% of cases. At last follow-up, pes cavus remained undercorrected in 80% of feet, but mean Djian angle had improved from 100 degrees to 111.3 degrees . Calcaneal valgus improved from 30.8 degrees to 24.8 degrees and the podoscopic footprint was normal in 51% of feet. In 74% of feet, adjacent joints presented progressive osteoarthritic degeneration. Subjectively, 70% of patients were very satisfied or satisfied with minor reservations. Objective outcome was excellent or good in 66% of feet.

DISCUSSION AND CONCLUSION: Outcome in terms of function, motion, complications and satisfaction was good, although pain relief results were poor. Anterior tarsectomy is able to correct initial pes cavus deformity and compensate anomalies of the hindfoot, but its correction capacity is limited, and its efficacy in case of clawfoot is poor. Anterior tarsectomy spares the adjacent Chopart complex and Lisfranc joints while inducing hypermobility, and leads to arthritis in 74% of cases. Better results are obtained in cases of reestablishment of the Méary-Tomeno line and of hindfoot valgus, as well as in cases of correction of equinus and clawfoot deformities. Worse results are observed in case of neurological evolutive disease or insufficient correction of the preceding deformities
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NewsBot · Jul 11, 2009

Osteotomies of the foot for cavus deformities in children.
Mubarak SJ, Van Valin SE.
J Pediatr Orthop. 2009 Apr-May;29(3):294-9.

BACKGROUND: The cavovarus foot has been defined as plantar flexion of the first ray. The usual cause is due to a muscle imbalance. The purpose of this study was to report our experience with selective, joint-sparing osteotomies of the foot that address each deformity in the cavovarus foot in a stepwise fashion. Most bony procedures for correction of cavus feet have centered on osteotomies across multiple joints or fusions.

METHODS: We report on stepwise osteotomies: (1) closing wedge to the first metatarsal, (2) opening plantar wedge of the medial cuneiform, (3) cuboid closing wedge, (4) and as needed second and third metatarsal osteotomies, calcaneal sliding osteotomies, and plantar fasciotomy and peroneus longus-to-brevis transfer. We measured all feet radiographically and clinically. RESULTS: We studied 20 feet in 13 patients with multiple etiologies. Nearly all feet were graded good to excellent on our outcome scale. Correction in Meary and Hibb angles was observed. There were no significant complications.

CONCLUSIONS: By performing a double osteotomy on the first ray (cuneiform and metatarsal), the cavus can be nearly fully corrected. The cuboid osteotomy provides increased mobility of the forefoot. The sliding calcaneal osteotomy should be used to improve any residual hindfoot varus. We recommend transferring the peroneus longus to brevis to balance the paralytic foot. The cavus foot needs to be addressed at the apex, while sparing the midtarsal joints and avoiding fusion. This sequence of osteotomies addresses all of the components of a cavus foot.
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NewsBot · Oct 21, 2009

A prospective study of Japas' osteotomy in paralytic pes cavus deformity in adolescent feet.
Chatterjee P, Sahu MK.
Indian J Orthop. 2009 Jul;43(3):281-5.

BACKGROUND: Pes cavus is a progressive and ugly deformity of the foot. Although initially the deformity is painless, with time, painful callosities develop under metatarsal heads and arthritis supervenes later in feet. Mild deformities can be treated with corrective shoes, or foot exercises. However, in others, operative treatment is imperative. Soft tissue operations are largely unsatisfactory and temporary. Bony operations give permanent correction. We present our series of 18 patients of pes cavus in the adolescent age group, treated by Japas' V-osteotomy of the tarsus.

MATERIALS AND METHODS: 18 patients of paralytic pes cavus deformity were treated by Japas osteotomy, between March 1995 and 2005, at our institute. The age of the patients ranged from 8.6 to 15 years (mean 11.3); 10 were boys and 8 girls. All cases had unilateral involvement, and all, but one, were post-polio cases.

RESULT: The mean follow-up is 5.4 years. Of the 18 patients, 14 had excellent or good corrections; 4 had poor correction/complications. However, those patients could be salvaged by triple arthordesis or Dwyer's calcaneal osteotomy.

CONCLUSION: Japas' osteotomy is a satisfactory option for correction of pes cavus deformity in adolescents. In patients who have rigid hind foot equinus or varus, however, the results are compromised.
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NewsBot · Oct 28, 2009

A Modified Jones Procedure for Managing Clawing of Lesser Toes in Pes Cavus: Long-term Follow-up in 8 Patients.
Sugathan HK, Sherlock DA.
J Foot Ankle Surg. 2009 November - December;48(6):637-641.

Pes cavus is a complex foot deformity in which surgical correction remains challenging. We treated lesser-toe clawing in 11 feet of 8 patients (5 women, 1 bilateral; 3 men, 2 bilateral) with a modified Jones procedure and assessed long-term functional outcomes. We reviewed case notes and completed the Bristol Foot Score, the modified American Orthopaedic Foot & Ankle Society Midfoot Score, and a patient satisfaction questionnaire by means of telephone interviews. Mean age of the patients at the time of surgery was 30 years (range, 10-58 years). Mean time from surgery to the last clinical follow-up was 7 years (range, 0.5-17 years), and mean time from surgery to the telephone interview was 9 years (range, 1-18 years). At the final clinical review, all 11 feet were improved, although 6 had minor complications. The mean Bristol Foot Score was 27 (range, 16-55), and the mean modified American Orthopaedic Foot & Ankle Society Midfoot Score was 76 (range, 47-90), indicative of excellent results. Half of the patients had mild persistent foot pain, but all were satisfied with the outcome. Based on our experience with this group of patients, the modified Jones procedure yields satisfactory correction of lesser toe clawing in patients with flexible pes cavus
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drsarbes · Oct 28, 2009

One thing that was omitted from the original post......

"Only cases achieving an unsatisfactory result followed less than 2 years were included."

Steve

NewsBot · Jun 10, 2011

Navicular excision and cuboid closing wedge for severe cavovarus foot deformities: a salvage procedure.
Mubarak SJ, Dimeglio A.
J Pediatr Orthop. 2011 Jul-Aug;31(5):551-6.

BACKGROUND:
The goals of cavus foot correction are to obtain a plantigrade foot with the heel in slight valgus position and to hopefully preserve joint motion in both the tarsal and metatarsal joints. The apex of many cavus deformities is near Chopart joint. We are reporting on a new technique involving navicular excision and cuboid osteotomy to correct severe stiff cavus feet.

METHODS:
A retrospective review of patients who underwent navicular excision and a cuboid dorsal closing wedge osteotomy to correct a rigid cavus foot deformity was performed. A total of 11 children and 16 feet were treated during the past 8 years at 2 centers.

RESULTS:
All feet had navicular excision and a cuboid dorsal closing wedge osteotomy to correct a rigid cavus foot deformity. The etiology of the deformity was as follows: multiply operated congenital clubfoot (5 feet), arthrogryposis (6 feet), and neurological deficits (5 feet). At a mean follow-up of 4.9 years, all had a plantigrade foot.

CONCLUSIONS:
This salvage procedure offers an alternative method to correct a severe stiff cavus deformity. The procedure is performed at the apex of the deformity and thus maximum correction can be obtained by this "wedge resection." The curved articular surfaces of the cuneiforms articulate with the head of the talus post navicular excision if no fusion is desired. Navicular excision has been used to correct children with vertical talus, but not previously reported as a method to handle severe cavus. It is a salvage procedure that should be considered to address severe rigid cavus.
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NewsBot · Jan 13, 2012

Metatarsal extension osteotomy without plantar aponeurosis release in cavus feet. The effect on claw toe deformity a radiographic assessment
A.K. Singh, P.J. Briggs
Foot and Ankle Surgery (Available online 12 January 2012)

Background
This study reviewed patients undergoing correction of cavus foot deformity by metatarsal extension osteotomy with preservation of the plantar aponeurosis, and assessed the correction achieved of the claw deformity of the toe by radiographic assessment.

Method
15 patients (18 feet) were reviewed clinically and radiographically. All feet required extension osteotomy of the first metatarsal and four patients (5 feet) had extension osteotomy of the first to fourth metatarsals. Hallux extension angle in relation to the 1st metatarsal and in relation to the ground was measured in all feet to estimate the degree of clawing of the hallux.

Results
13 patients (15 feet) were satisfied with the outcome of their surgery and also the appearance of their foot. The mean radiographic change in the hallux extension angle in relation to the 1st metatarsal was 16°, and in relation to the ground was 7°. These changes were statistically significant.

Conclusion
Our results indicate an improvement in the claw toe deformity and we recommend preservation of the plantar aponeurosis in corrective surgery for cavus foot.
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NewsBot · Apr 15, 2014

Resection of the Fifth Metatarsal Base in the Severe Rigid Cavovarus Foot
Raheel Shariff, FRCS, Mark S. Myerson, MD, Ezequiel Palmanovich, MD
Foot & Ankle International April 7, 2014

Background: Cavovarus deformity associated with neuromuscular imbalance is a challenging pathology. Most of these deformities lead to pressure symptoms at the lateral border of the foot. This leads to pain, callosity, and commonly fracture of the fifth metatarsal base. This study reports the outcome of a cohort of patients who underwent an adjunctive procedure of resection of the fifth metatarsal, either partial or complete, in conjunction with cavovarus foot reconstruction to offload the lateral border of the foot.

Methods: This was a retrospective study looking at the clinical and radiographic outcome of patients with an underlying neuromuscular problem with a cavovarus foot who underwent a resection of the fifth metatarsal. This was used as an adjunctive procedure during reconstruction for lateral foot pressure overload symptoms. Case notes and radiographs were reviewed. The distance on weight-bearing radiographs from the inferior most part of the bony prominence on the lateral border of the foot to the floor was measured and compared between pre- and postoperatively. Eighteen patients met the inclusion criteria. Mean age was 55 years. Mean follow-up was 32 months.

Results: Fourteen patients had a partial base of fifth metatarsal resection, and 4 had a complete fifth ray resection. Radiographic measurements showed a statistically significant improvement in the distance from the inferior most part of the bony prominence on the lateral border of the foot to the floor between pre- and postoperative radiographs. Sixteen patients reported a significant improvement in their symptoms, 2 had some persistent lateral overload symptoms.

Conclusion: The technique described in this study has not been reported previously for this indication. We believe it is a good adjunctive procedure in cavovarus foot reconstruction for patients suffering from lateral pressure overload. We describe strict guidelines and indications for this procedure.
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NewsBot · Jun 10, 2014

A prospective study of midfoot osteotomy combined with adjacent joint sparing internal fixation in treatment of rigid pes cavus deformity
Zhou Y, Zhou B, Liu J, Tan X, Tao X, Chen W and Tang K
Journal of Orthopaedic Surgery and Research 2014, 9:44 (5 June 2014)

Background
Midfoot osteotomy has been previously confirmed to be a good method to correct pes cavus. How to fix the osteotomy and which point to choose for the procedure has been a focus for most surgeons. The aim of this study was to analyse the outcomes of a series of patients who had been treated for pes cavus deformity using midfoot osteotomy combined with adjacent joint sparing internal fixation.

Materials and methods: Between 2008 and 2012, 17 patients with a mean age of 16.8 years (12-36 years) were tracked after treatment by midfoot osteotomy combined with adjacent joint sparing internal fixation with three cannulated screws between the Lisfranc line and Cyma line. Clinical outcomes were assessed by measuring improvements of appearance and function, American Orthopedic Foot and Ankle Society (AOFAS) scores, and radiographic changes.
Results
The mean follow-up time was 25.3 months (range, 10-50). The mean healing time from the osteotomy was 7.8 weeks (range, 6-12). The appearance and weight-bearing function were significantly improved in all patients. At a final follow-up, the mean AOFAS score was 75.8/100 points (range, 63-90). The mean Meary's angle, calcaneal pitch angle, tibiotalar angle, and Hibb's angle values improved from 26.3 to 5.5, 44.5 to 28.3, 133.1 to 100.8 and 66.9 to 41.1, respectively. Adjacent joints presented no obviously arthritic degeneration at the follow-up. Subjectively, 94.1% of patients were very satisfied or satisfied with minor reservations. Objective outcomes were excellent or good in 88.2% of feet.
Conclusion
For the treatment of rigid pes cavus deformity, extra-articular midfoot osteotomy combined with adjacent joint sparing internal fixation is effective and safe. This surgical technique is especially effective with low rates of arthritic degeneration and joint stiffness in the adjacent joints and little reduction of ankle and foot flexibility.
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NewsBot · Jun 15, 2014

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

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.
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NewsBot · Sep 27, 2016

An Algorithm to Assist the Surgical Decision Making in the Operative Management of the Cavovarus Foot
John E. Grice et al
Foot & Ankle Orthopaedics September 2016 – December 2016 vol. 1 no. 1

Introduction/Purpose: The cavovarus foot is a complex deformity caused by muscle imbalance, soft-tissue contracture and secondary bony abnormality. It is a combination of hindfoot, midfoot and forefoot deformity and the decision making process for surgical management can be difficult. The process of deciding which combination of procedures is required is often poorly understood. We present an algorithm to assist with this decision making.
Methods: We have analyzed a single surgeon's experience of cavovarus foot correction, from a consecutive series of 60 patients over 6 years, to develop an algorithm to guide operative decision making. Cases included cavovarus deformity secondary to cerebral palsy, Frie-dreich's ataxia, Charcot Marie Tooth disease, post-traumatic contracture, post-cerebrovascular accident, iatrogenic post-surgery and physiological cavus. We have taken a systematic appr oach to each component of the deformity in order to generate the algorithm.
Results: To assist in rationalizing the traditional ‘a-la-carte’ approach, our algorithm describes what we believe are the indications for a variety of surgical interventions, including soft tissue contracture release, osteotomies of the hindfoot, midfoot and forefoot, tendon transfer and soft tissue balancing, and arthrodesis. We detail the decision making process for each surgical option and give the reasons for each decision. We have also reviewed the available literature on this topic, to produce an evidence-based and useable means of surgical planning.
Conclusion: The surgical decision making process in the management of the cavovarus foot is complex. We believe that this algorithm, based on extensive personal experience and up-to-date published evidence, provides a clear and proven framework on which surgical decision making can be guided and justified.
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NewsBot · Dec 24, 2016

Combined triple arthrodesis and soft tissue procedures in management of rigid cavus foot in adults
Ahmed E Osman, Wael El-Adly, Yaser E Khalifa, Mohammed G Hassan
International Journal of Multidisciplinary Research and Development Volume 3; Issue 11; November 2016; Page No. 141-145

Type of study: prospective study.
Objective: Demonstration the role of combined bony procedures using triple arthrodesis and soft tissue procedures in correction of
cavus foot deformity in adults.
Background: Rigid cavus deformity is a complex foot deformity which has different forms and results from different aetiologies.
Triple arthrodesis is considered as a golden standard for treatment of such deformities. Combined bony and soft tissue procedures
are needed for correction of deformity. Tendon transfer is important to restore the muscle balance around the foot.
Patients and Methods: Between 2013 – 2015 fifteen feet with rigid cavus deformity were corrected surgically with Ryerson's
triple arthrodesis (five feet) or Lambrinudi triple arthrodesis (10 feet) combined with tibialis posterior tendon or long toes flexor
tendons transfer to the dorsum of the foot. Follow up period ranged from 20 to 47 months (mean 32.17 ± 7.62). All patients were
assessed clinically and radiologically for determination of the amount of correction. The outcome was graded according to criteria
of Angus and Cowell.
Results: the outcome was good in two feet, fair in eleven feet and poor in two feet. The correction in the hindfoot alignment and in
the range of ankle joint motion was significant. The correction in the radiological parameter was statistically insignificant.
Conclusions: Successful treatment of rigid cavus foot deformity requires comprehensive understanding of the nature of the
deformity and its pathology. Adding tendon transfer to the corrective bony procedure is mandatory to restore the muscle balance
around the foot and to prevent the recurrence.
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NewsBot · May 16, 2017

The adult cavus foot
Carlos Maynou, Christophe Szymanski, Alexis Thiounn
EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160077.

Cavovarus deformity can be classified by the severity of malalignment ranging from a subtle and flexible to a severe and fixed cavovarus deformity of the foot.

In the mild cavovarus foot, careful clinical assessment is required to identify the deformity.

Weight-bearing radiographs are necessary to indicate the apex of the deformity and quantify the correction required.

Surgery is performed when conservative measures fail and various surgical procedures have been described, including a combination of soft-tissue releases, tendon transfers and osteotomies, all with the aim of achieving a plantigrade and balanced foot.

Joint-sparing surgery is the best option in flexible cavovarus foot even in Charcot-Marie-Tooth (CMT) disease (peroneal muscular atrophy).

Arthrodesis is indicated in severe rigid cavus foot or in degenerative cases.
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NewsBot · Jun 24, 2018

Innovative treatment for pes cavovarus: a pilot study of 13 children
Ignacio Sanpera Jr, Guillem Frontera-Juan, Julia Sanpera-Iglesias & Laura Corominas-Frances
Acta Orthopaedica: 18 Jun 2018

Background and purpose — Pes cavovarus (PCV) is a complex deformity, frequently related to neurological conditions and associated with foot pain, callosities, and walking instability. The deformity has the tendency to increase during growth. Orthotic treatment is ineffective and surgery may be troublesome. We present the preliminary results of a new mini-invasive surgical technique for correction of this foot deformity.

Patients and methods — We operated on 13 children (24 feet), age 7–13 years. In 7 children the deformity was neurological in origin. The surgical technique included a dorsal hemiepiphysiodesis of the 1st metatarsal, and a plantar fascia release. The clinical deformity, hindfoot flexibility, and foot callosities, together with a radiological assessment (Meary angle, calcaneal pitch, and talo-calcaneal angle), was done pre- and postoperatively. At final check-up, after a median of 28 months (12–40), the Oxford Ankle Foot Questionnaire for children (OXAFQ-C) was used to assess patient satisfaction. The primary outcome was the hindfoot varus correction.

Results — All the operated feet improved clinically and radiologically. Heel varus improved from a mean 6° preoperatively to 5° valgus postoperatively. In those children where treatment was initiated at a younger age, full correction was achieved. Footwear always improved.

Interpretation — This treatment may offer a less aggressive alternative in the treatment of PCV in young children and may eventually reduce the amount of surgery needed in the future.
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NewsBot · Feb 27, 2019

Long-term outcome after Lambrinudi arthrodesis: How they're doing after three decades.
So LWN, Kuong EE, To KM, Leong JCY, Chow W1.
J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499019826492

OBJECTIVE::
The aim of the study is to investigate the long-term outcome of patients who received Lambrinudi arthrodesis for severe equinovarus deformities.

METHODS::
This is a single-center, retrospective study of patients who received Lambrinudi triple arthrodesis of the foot. Both clinical and radiological information were analyzed.

RESULTS::
We were able to review 10 patients suffering from severe equinus deformities mostly as a result of or in association with poliomyelitis (8 of 10) who received Lambrinudi arthrodesis. The majority (7 of 10) of our patients had fair to good outcome at an average follow-up of 37 years. Specifically, six of eight polio patients had fair to good outcome. Of the X-rays available for assessment, the majority of patients showed radiological signs of adjacent joint arthritis; however, the presence of such did not invariably lead to poor clinical outcome.

CONCLUSION::
Lambrinudi arthrodesis is a treatment option with favorable long-term outcome for patients with severe, fixed equinus deformities.
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NewsBot · Jul 10, 2022

Evaluation and Management of Cavus Foot in Adults: A Narrative Review
Boquan Qin et al
J Clin Med. 2022 Jun 26;11(13):3679

Objective: Cavus foot is a deformity defined by the abnormal elevation of the medial arch of the foot and is a common but challenging occurrence for foot and ankle surgeons. In this review, we mainly aim to provide a comprehensive evaluation of the treatment options available for cavus foot correction based on the current research and our experience and to highlight new technologies and future research directions.

Methods: Searches on the PubMed and Scopus databases were conducted using the search terms cavus foot, CMT (Charcot-Marie-Tooth), tendon-transfer, osteotomy, and adult. The studies were screened according to the inclusion and exclusion criteria, and the correction of cavus foot was analyzed based on the current research and our own experience. At the same time, 3D models were used to simulate different surgical methods for cavus foot correction.

Results: A total of 575 papers were identified and subsequently evaluated based on the title, abstract, and full text. A total of 84 articles were finally included in the review. The deformities involved in cavus foot are complex. Neuromuscular disorders are the main etiologies of cavus foot. Clinical evaluations including biomechanics, etiology, classification, pathophysiology and physical and radiological examinations should be conducted carefully in order to acquire a full understanding of cavus deformities. Soft-tissue release, tendon-transfer, and bony reconstruction are commonly used to correct cavus foot. Surgical plans need to be customized for different patients and usually involve a combination of multiple surgical procedures. A 3D simulation is helpful in that it allows us to gain a more intuitive understanding of various osteotomy methods.

Conclusion: The treatment of cavus foot requires us to make personalized operation plans according to different patients based on the comprehensive evaluation of their deformities. A combination of soft-tissue and bony procedures is required. Bony procedures are indispensable for cavus correction. With the promotion of digital orthopedics around the world, we can use computer technology to design and implement cavus foot operations in the future.
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NewsBot · Jan 11, 2023

Lateralizing Calcaneal Osteotomy and First Metatarsal Dorsiflexion Osteotomy for Cavovarus Foot and Peroneal Sheath Release with Peroneus Brevis Repair for Peroneal Tendinopathy in Chronic Ankle Instability and Sprain
Kazuki Kisamori et al
Cureus. 2022 Dec 5;14(12):e32235

A 47-year-old male presented with an eight-year history of pain in the posterior inferior part of the lateral malleolus, ankle instability, and repeated right-sided ankle sprains. He had pes cavus and hind-foot varus in his right foot, which is an unknown congenital entity or acquired with tenderness in the inferior peroneal retinaculum. There is no deformity in his left foot. The pain was elicited by the movement of the subtalar joint. Imaging revealed a high medial longitudinal arch, an enlarged peroneal tubercle, thinning of the peroneus brevis tendon, and hypertrophy of the peroneus longus tendon. We diagnosed peroneal tendinopathy with cavovarus foot in a chronic ankle sprain. The supination generated by pes cavus was thought to be aggravating the peroneal tendinopathy and causing the ankle sprains. Incision of the peroneal tendon sheath, repair of the peroneus brevis tendon, lateralizing calcaneal osteotomy, and first metatarsal dorsiflexion osteotomy were performed. At the one-year follow-up, Meary's angle was corrected to 0°, the calcaneal pitch was corrected to 20°, and the hindfoot varus was improved. He was pain-free and reported no further instability when walking. His Japanese Society of Surgery of the Foot ankle-hindfoot scale score improved from 59 preoperatively to a maximum of 100 and the Self-Administered Foot Evaluation Questionnaire gave an almost perfect score for non-sports-related items and a score of 83.3 for sports-related items. We believe that the addition of treatment of the pes cavus, which was the center of the pathology, as well as treatment of the peroneal tendon, resulted in a good outcome.
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High Arch, Pes Cavus.. Advice on impending surgery needed

1st MPJ ulcerations in high risk 'pes cavus' feet

Pes Cavus & Mortons Neuroma

Right foot is Pes Cavus and supinated

Outcome of non-surgical treatment of neurologic pes cavus

Unilateral Pes cavus

Neurological assessment of idiopathic pes cavus

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