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Surgical Treatment of Cavus Foot in Charcot-Marie-Tooth Disease

March 15, 2015

Contributors: Matteo Nanni, MD; Daniele Fabbri, MD; Mohammadreza Chehrassan, MD; Raffaele Borghi, MD; Federico Pilla, MD; Ilaria Sanzarello, MD; Francesco Traina, MD, PhD; Sandro Giannini, MD; Cesare Faldini, MD; Cesare Faldini, MD

INTRODUCTION: The Charcot-Marie-Tooth disease (CMT) is the single most common diagnosis associated with cavus foot. The imbalance between intrinsic and extrinsic muscles have been suggested as the main etiopathogenetic cause of cavus foot in CMT. The aim of the surgical treatment is to correct the deformity in order to obtain a plantigrade foot; however, in case of flexible deformity and in the absence of degenerative arthritis, preserving the foot and ankle mobility should be taken in consideration. In case of CMT disease, due to the complexity of cavus deformity, different surgical techniques should be applied during the surgery in order to close the morphology of the foot to a plantigrade one. However this may not be possible without good preoperative planning and comprehensive clinical and imaging studies which provide better understanding of the deformity. Briefly, the surgical steps in our video include plantar fascia release, hindfoot correction and stabilization, midfoot osteotomy, dorsiflexion osteotomy of the first metatarsal, and the extensor hallucis longus tendon transfer (Jones procedure). The aim of this video is to show the step by step surgical techniques of cavus foot correction in a male patient affected with CMT disease.

METHODS: Twenty-four cavus feet in 12 patients affected by CMT were operated using this technique; one of them is in our video presentation. Clinical evaluation was summarized with Maryland Foot Score. Radiographic evaluation assessed calcaneal pitch, calcaneus-first metatarsal angle (Hibb's angle), talo-first metatarsal angle (Meary angle), and absence of joint degenerative changes. Only flexible deformities, with varus of the heel reducible with Coleman-Andreasi test, and without joint degenerative arthritis were operated in these case series. Mean follow up was six years (range, 2-13 years). Mean Maryland Foot Score was 72 preoperatively and 86 postoperatively. The postoperative result was rated excellent in 12 feet (50%), good in 10 (42%), fair in two (8%). Mean calcaneal pitch was 34° preoperatively and 24° at follow up; mean Hibb's angle was 121° preoperatively and 136° at follow up; mean Meary's angle was 25° preoperatively and 2° at follow up.

RESULTS: Plantar fasciotomy, midtarsal osteotomy, Jones procedure, and dorsiflexion osteotomy of the first metatarsal allow adequate correction of flexible cavus foot in CMT. Conversely, in presence of bony deformities and/or joint degenerative arthritis, we believe that modeling arthrodesis (subtalar, midtarsal, triple) should be considered.

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