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Metatarsal osteotomies cavus

Cesare Faldini, Francesco Traina, Matteo Nanni, Antonio Mazzotti, Carlotta Calamelli, Daniele Fabbri, Camilla Pungetti, Sandro Giannini
Charcot-Marie-Tooth disease is the single most common diagnosis associated with cavus foot. The imbalance involving intrinsic and extrinsic muscles has been suggested as the main pathogenetic cause of cavus foot in this disease. The goal of surgical treatment is to correct the deformity to obtain a plantigrade foot. In the presence of a flexible deformity and the absence of degenerative arthritis, preserving as much as possible of the overall range of motion of the foot and ankle is advisable. Twenty-four cavus feet in twelve patients with Charcot-Marie-Tooth disease were included in the study...
March 18, 2015: Journal of Bone and Joint Surgery. American Volume
Adham Elgeidi, Mazen Abulsaad
PURPOSE: The "bean-shaped foot" exhibits forefoot adduction and midfoot supination, which interfere with function because of poor foot placement. The purpose of the study is a retrospective evaluation of patients who underwent a combined double tarsal wedge osteotomy and transcuneiform osteotomy to correct such a deformity. METHODS: Twenty-seven children with 35 idiopathic clubfeet were treated surgically by combined double tarsal wedge osteotomy (closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy) and transcuneiform osteotomy between 2008 and 2012...
October 2014: Journal of Children's Orthopaedics
Troy J Boffeli, Jessica A Tabatt
Charcot-Marie-Tooth disease is a neuromuscular disorder that commonly results in a predictable pattern of progressive bilateral lower extremity weakness, numbness, contracture, and deformity, including drop foot, loss of ankle eversion strength, dislocated hammertoes, and severe cavus foot deformity. Late stage reconstructive surgery will be often necessary if the deformity becomes unbraceable or when neuropathic ulcers have developed. Reconstructive surgery for Charcot-Marie-Tooth deformity is generally extensive and sometimes staged...
July 2015: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Sophia E Deben, Gregory C Pomeroy
The subtle cavovarus foot (SCF) is a mild malalignment caused by either primary hindfoot varus or a plantarflexed first ray, resulting in a typical constellation of symptoms because of altered foot mechanics. Key clinical signs are a peek-a-boo heel and a positive Coleman block test. The cavovarus position places lateral ankle soft-tissue structures, such as the anterior talofibular ligament and the peroneal tendons, on stretch during normal gait. This can lead to common conditions such as lateral ankle instability, peroneal tendon tears, and stress fractures of the lateral metatarsals and cuboid...
August 2014: Journal of the American Academy of Orthopaedic Surgeons
Dennis S Weiner, Kerwyn Jones, David Jonah, Martin S Dicintio
This article reviews historical approaches to the various osteotomies in the treatment of rigid cavus feet in children, with an emphasis on the biplanar nature of historical osteotomies. The Akron dome midfoot osteotomy is performed at the apex of the rigid cavus deformity and allows for maximum correction in any plane, and for varus, valgus, dorsal, plantar, and rotational correction. In that regard, the Akron dome midfoot osteotomy provides the greatest amount of multiplanar correction. It does not, however, provide correction of hindfoot deformities or deformity distal to the neck of the metatarsal...
December 2013: Foot and Ankle Clinics
Gökhan Cakmak, Ulunay Kanatlı, Barış Kılınç, Haluk Yetkin
OBJECTIVE: In this study, we tried to evaluate the effect of pronation and the inclination of the first metatarsal on the measurement of distal metatarsal articular angle (DMAA) in 10 cadaver first metatarsals. METHODS: Ten cadaver first metatarsals were fixed to a device. This device can change the inclination and pronation angles of the metatarsal. 15-30-45 degrees of inclination and 0-10-20 degrees of pronation were applied to the metatarsals. After applying radio-opaque putty to the medial and lateral articular edges and metatarsal dorsal diaphyseal ridge, the X-ray and digital images were taken at different degrees of inclination and pronation...
2013: Acta Orthopaedica et Traumatologica Turcica
Tun Hing Lui
Osteotomy of the first metatarsal in the sagittal plane is useful in correction of numerous deformity of the foot. Plantarflexion osteotomy of the first metatarsal can be used to treat hallux rigidus, hallux limitus, forefoot varus in flatfoot deformity and iatrogenic metatarsus primus elevates. Dorsiflexion osteotomy of the first metatarsal is an important component in surgical correction of pes cavus. It is also indicated in recalcitrant diabetic neuropathic ulcers at the first metatarsal head. We described a minimally invasive technique of sagittal plane corrective osteotomy of the first metatarsal, which can be either a plantarflexion or dorsiflexion one...
February 2014: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
A K Singh, P J Briggs
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...
September 2012: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Kryspin Niedzielski, Zbigniew Lipczyk, Filip Klawe, Paweł Flont
Metatarsus adductus is usually a morphologic feature of the clubfoot or occurs as an isolated defect. Such deformation causes shortening of the medial foot column and lengthening of the lateral. The purpose of the study is a retrospective evaluation of long-term therapeutic effects in a group of patients, who underwent closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy. Surgery was performed in 19 persons, procedure was applied to 26 feet, of which 3 presented congenital metatarsus adductus and 23 presented recurrent clubfoot...
September 2010: Chirurgia Narzadów Ruchu i Ortopedia Polska
Khalid Shirzad, Carter D Kiesau, James K DeOrio, Selene G Parekh
Lesser toe deformities are caused by alterations in normal anatomy that create an imbalance between the intrinsic and extrinsic muscles. Causes include improper shoe wear, trauma, genetics, inflammatory arthritis, and neuromuscular and metabolic diseases. Typical deformities include mallet toe, hammer toe, claw toe, curly toe, and crossover toe. Abnormalities associated with the metatarsophalangeal (MTP) joints include hallux valgus of the first MTP joint and instability of the lesser MTP joints, especially the second toe...
August 2011: Journal of the American Academy of Orthopaedic Surgeons
Stephen M Hewitt, Mark Tagoe
Charcot-Marie-Tooth disease is a complex group of motor and sensory disorders presenting with varying levels of deformity dependent on the chronology and specific subgroup of the disease. In this report, we discuss a 19-year-old man with Charcot-Marie-Tooth 1A, a progressive and aggressive form of hereditary sensorimotor neuropathy, with rigid forefoot and rearfoot deformity. The authors discuss the etiology, tests, and sequential surgical management of this condition, focusing on a triple arthrodesis including a closingwedge subtalar joint fusion and a dorsal closing wedge osteotomy of the first metatarsal...
March 2011: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
A E E P M Leeuwesteijn, E de Visser, J W K Louwerens
OBJECTIVES: The purpose of this paper was to retrospectively evaluate the short-term to mid-term results of combined first ray proximal dorsiflexion osteotomy and soft tissue surgery in treatment of pes cavovarus with a fixed plantar flexed first ray and a passively correctable tarsus due to Charcot-Marie-Tooth disease. PATIENTS AND METHODS: Between January 1995 and July 2005, thirty-three patients with pes cavovarus deformity due to Charcot-Marie-Tooth disease were included...
September 2010: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Protyush Chatterjee, M K Sahu
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...
July 2009: Indian Journal of Orthopaedics
Scott J Mubarak, Scott E Van Valin
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...
April 2009: Journal of Pediatric Orthopedics
Arjandas Mahadev, Ismail Munajat, Azura Mansor, James H P Hui
UNLABELLED: Residual deformity in resistant clubfoot is not uncommon. The "bean-shaped foot" exhibits forefoot adduction and midfoot supination and may interfere with function due to poor foot placement. For children less than 5 years of age we describe a corrective procedure combining a closing wedge cuboidal osteotomy and trans-midfoot rotation procedure without a medial opening wedge osteotomy. We retrospectively reviewed twelve patients (14 feet), mean age 4.7 years (range, 4-5 years), who had undergone the procedure to correct forefoot adduction and midfoot supination deformities...
May 2009: Clinical Orthopaedics and related Research
Christina M Ward, Lori A Dolan, D Lee Bennett, Jose A Morcuende, Reginald R Cooper
BACKGROUND: Cavovarus foot deformity is common in patients with Charcot-Marie-Tooth disease. Multiple surgical reconstructive procedures have been described, but few authors have reported long-term results. The purpose of this study was to evaluate the long-term results of an algorithmic approach to reconstruction for the treatment of a cavovarus foot in these patients. METHODS: We evaluated twenty-five consecutive patients with Charcot-Marie-Tooth disease and cavovarus foot deformity (forty-one feet) who had undergone, between 1970 and 1994, a reconstruction consisting of dorsiflexion osteotomy of the first metatarsal, transfer of the peroneus longus to the peroneus brevis, plantar fascia release, transfer of the extensor hallucis longus to the neck of the first metatarsal, and in selected cases transfer of the tibialis anterior tendon to the lateral cuneiform...
December 2008: Journal of Bone and Joint Surgery. American Volume
Maria Vlachou, Alex Beris, Dimitris Dimitriadis
Nineteen ambulant patients (children and adolescents, 23 feet), with mild-to-moderate cavus and claw feet of neuromuscular etiology, underwent a modified Chuinard-Baskin operation, combining long toe extensor tendon transfer to the metatarsals with distal tenodesis onto the proximal phalanx. The technique aims to improve forefoot deformity and metatarsophalangeal dysfunction, and to enhance ankle dorsiflexion. Transcutaneous flexor tenotomies in several toes, and additional complementary surgery in the middle and hindfoot (plantar soft tissue releases, tendon lengthenings, and/or transfers and osteotomies/fusions) were also performed, when required...
July 2008: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Philippe Wicart, Raphael Seringe
Neurological pes cavovarus is a challenging deformity to treat during childhood. Based on physiopathology, we propose the following original surgical procedure. Plantar-opening wedge osteotomy of the three cuneiform bones, preceded by selective plantar release, corrects forefoot pronation which is the primum movens of the deformity, and corrects the cavus at its apex. A calcaneal valgisation closing wedge osteotomy, is indicated if pre-operative planning revealed subtalar joint stiffness, incompatible with secondary hind foot realignment in valgus...
January 2006: Journal of Pediatric Orthopedics
Brandon L Tullis, Robert W Mendicino, Alan R Catanzariti, Timothy J Henne
This article presents the results of a retrospective chart and radiographic review of 11 feet (8 patients) that underwent a Cole midfoot osteotomy from February 1998 through October 2000 at the Western Pennsylvania Hospital. The average time to follow-up was 23 months (range, 11 to 29.5 months). A 100% bony union rate was achieved, with an average time to radiographic union of 2.3 months (range, 1.2 to 4.5 months). The average time until full weightbearing was 3.3 months (range, 2 to 4.25 months). The average preoperative talo-first metatarsal angle on an anteroposterior radiograph was 8...
May 2004: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
G J Sammarco, R Taylor
Cavovarus foot can be painful and disabling owing to deformity and instability. A method of surgical correction is presented with osteotomies of the forefoot and the hindfoot. The technique avoids arthrodesis while preserving joint motion, lowering the height of the arch, and correcting varus and adductus deformity. Increased ankle stability, elimination of the risk of stress fracture, decreased pain are expected outcomes.
September 2001: Foot and Ankle Clinics
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