Metatarsal osteotomies cavus

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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.

The authors report a series of Weil's cervicocapital metatarsal osteotomies which were performed to treat central metatarsalgias. The series included 70 central metatarsalgias treated by osteotomy of one to four metatarsals. There was an excess of length of one or several metatarsals in all cases; there were 30 metatarsophalangeal dislocations. The results were evaluated according to Kitaoka's criteria: 20 were quoted very good, 26 good, 9 fair and 3 poor. The osteotomy gave an overall improvement regarding pain and shoe fitting but the mobility of the MP joint was reduced in all cases...

Twenty-one feet in fifteen patients underwent osteotomies of the calcaneus and one or more metatarsals for symptomatic cavovarus foot deformity. Seven (nine feet) were male, and eight (twelve feet) were female. The etiology included hereditary motor sensory neuropathy (HMSN) (fifteen feet), post-polio syndrome (two feet), sacral cord lipomeningocele (two feet), parietal lobe porencephalic cyst (one foot), and idiopathic peripheral neuropathy (one foot). Presenting complaints were metatarsalgia (fifteen feet), ankle instablility (five), and ulceration beneath the second metatarsal head (one foot)...

We carried out a cross-sectional study in 51 patients (81 feet) with a clawed hallux in association with a cavus foot after a modified Robert Jones tendon transfer. The mean follow-up was 42 months (9 to 88). In all feet, concomitant procedures had been undertaken, such as extension osteotomy of the first metatarsal and transfer of the tendon of the peroneus longus to peroneus brevis, to correct the underlying foot deformity. All patients were evaluated clinically and radiologically. The overall rate of patient satisfaction was 86%...

The authors have performed 34 Dwyer's calcaneal osteotomies in children with pes cavus confined to the medial arch in non-paralytic lesions (poliomyelitis and spina bifida were excluded). In 12 cases it was associated with osteotomy of the 1st metatarsal or with plantar release. No arthrodeses were performed in these 34 cases. After an average follow-up of five years the results were doubtful: in 24 instances the deformity was the same or worse. In 21 cases a secondary operation was necessary. The authors considered that the Dwyer's procedure corrects only the varus of the heel which is a secondary deformity...

The cavovarus foot is a complex deformity of the forefoot and hindfoot, frequently of neuropathologic etiology. A progressive spinal or peripheral neuromuscular disorder must be excluded by a thorough clinical evaluation. With the failure of nonoperative modalities, surgical options depend on patient age, etiology of the deformity, and the constellation and flexibility of the defects observed. If the hindfoot varus is flexible, correction of the cavus and forefoot pronation through extensive plantar release and metatarsal osteotomies is reliable...

Thirty-nine patients with pes cavus-type deformities were treated with osteotomy of the proximal metatarsals for the cavus component of the deformity. Fifty operations were followed for an average of 15 years, many for up to 26 years. Of the 39 patients, 11 had bilateral involvement. Each patient was clinically evaluated for postoperative mobility and categorized according to the Massachusetts General Hospital rating scale. Excellent or good results were obtained in 84% of the proximal metatarsal osteotomies...

The difficulty of the exact adjustment of the first metatarsal's raising by dorsal cuneiform cutting and osteosynthesis, brought the authors to prefer proximal rafter osteotomy of the first metatarsal in the treatment of adult's anterior and medial pes cavus. Early weight bearing with a plaster cast or a wooden-shoe allowed the spontaneous raising of the metatarsal and an equal distribution of load between all the metatarsals. The excellent results reached by that single procedure in nine cases during ten years justify to suggest it for treatment of adult's anterior and medial pes cavus...