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Nogod SA, Osman MA, Fatooh MS, Khairy AM, Abd-Elmaged HM, Nubi OG. Cavovarus deformity of one foot with planovalgus deformity of the contralateral foot (Wind-swept heels): A case report. JOURNAL OF MUSCULOSKELETAL SURGERY AND RESEARCH 2023; 7:142-146. [DOI: 10.25259/jmsr_20_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Normal alignment of the arches and adequate stability is essential for the foot to function correctly. Pes planus and pes cavus are fairly common foot deformities, but it is uncommon to see both in the same patient simultaneously. This study aimed to describe the clinical presentation and prognosis of an uncommon combination of bilateral foot abnormalities named “windswept heels” resembling windswept knees. A 43-year-old female employee experienced frequent pain in her right foot and swelling and pain in her left foot, mainly when walking barefoot. She had a severe cavovarus deformity of the right foot with pressure callosities on the lateral side, clawing of the toes, and a positive Coleman’s block test. With the loss of the medial arch, severe heel valgus, and forefoot abduction, the left foot developed a planovalgus deformity. The left foot’s talus-first metatarsal angle and the right foot’s calcaneal inclination angle increased on weight-bearing radiographs. The left foot underwent staged surgical treatments, including medial sliding calcaneal osteotomy, gastrocnemius recession, and cotton osteotomy. For the right foot, lateral sliding calcaneal osteotomy, plantar fasciotomy, and peroneus longus tendon transfer. The American Orthopaedics Foot and Ankle Society Score (AOFAS) was used to measure the clinical and functional outcomes. At 1 year, her AOFAS scale was 85 compared to 59 before surgery. Since this presentation resembles the windswept knee deformity, we propose calling this disorder windswept heel deformity.
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Affiliation(s)
- Sami A Nogod
- Department of Orthopedics, Al-Neelian Unversity, Khartoum, Sudan
| | - Mohamed A Osman
- Department of Orthopedics, Al-Neelian Unversity, Khartoum, Sudan
| | | | - Alaa M Khairy
- Department of Orthopedics, Sudan Medical Specialization Board, Khartoum, Sudan
| | | | - Osama G Nubi
- Department of Public Health, Al-Neelian Unversity, Khartoum, Sudan,
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Chen J, Ramanathan D, Adams SB, DeOrio JK. Midterm Clinical and Radiographic Outcomes of the Calcaneal Z-Osteotomy for the Correction of Cavovarus Foot. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114221146986. [PMID: 36632335 PMCID: PMC9827521 DOI: 10.1177/24730114221146986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background The Malerba calcaneal Z-osteotomy is an operative procedure to treat the hindfoot varus component of adult cavovarus deformity. Basic science studies support the corrective ability of this osteotomy. However, there have been no published midterm clinical and radiographic results. The purpose of this article is to describe the radiographic and clinical improvement in a series of patients treated with this osteotomy. Methods A retrospective chart review identified 14 feet in 12 patients from January 2013 to August 2018 who met minimal follow-up criteria. Preoperative visual analog scale (VAS) scores, Foot Function Index (FFI) scores, and American Orthopaedic Foot & Ankle Society (AOFAS) scores were compared with postoperative scores. Preoperative Meary angle, calcaneal pitch, and hindfoot alignment were also compared with postoperative measurements. Complications and radiographic union were recorded. Results At a mean of 80 months, VAS, FFI, and AOFAS scores improved from 7.86 to 1.64, 57.78% to 18.11%, and 39.57 to 80.71, respectively (all P < .001). At a mean of 15 months, Meary angle, calcaneal pitch, and hindfoot alignment improved from 11.14 to 6.64 degrees (P < .001), 30.93 to 27.43 degrees (P = .005), and 19.83 degrees varus to 8.50 degrees varus (P < .001). There was 1 nonunion and 1 postoperative sural nerve neuralgia, but both patients ultimately did well clinically. There were no instances of postoperative tarsal tunnel syndrome. All patients stated that they would have the procedure done again. Conclusion The calcaneal Z-osteotomy is an effective method to treat adult hindfoot cavovarus deformity. All patients had good clinical outcomes with minimal complications. Level of Evidence Level IV, case series.
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Affiliation(s)
- Jie Chen
- Department of Orthopaedic Surgery and
Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Samuel B. Adams
- Department of Orthopaedic Surgery, Duke
University, Durham, NC, USA
| | - James K. DeOrio
- Department of Orthopaedic Surgery, Duke
University, Durham, NC, USA
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Kubo H, Krauspe R, Hufeland M, Lipp C, Ruppert M, Westhoff B, Pilge H. Radiological outcome after treatment of juvenile flatfeet with subtalar arthroereisis: a matched pair analysis of 38 cases comparing neurogenic and non-neurogenic patients. J Child Orthop 2019; 13:346-352. [PMID: 31489039 PMCID: PMC6701442 DOI: 10.1302/1863-2548.13.190046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Therapy of juvenile neurogenic flatfoot (JNF) with subtalar arthroereisis (SA) is currently under critical clinical investigation. In this retrospective matched pair analysis, the radiological outcome after arthroereisis in paediatric patients with infantile cerebral palsy and JNF was compared with children with juvenile flatfeet (JF) without neurological diseases. METHODS From October 2007 to April 2018 80 patients with 149 flatfeet underwent surgery with SA. Inclusion criteria were: 1) JNF or JF with age at surgery ≤ 13 years; 2) treatment with SA; 3) presence of three sets of biplane radiographs (preoperative, postoperative and follow-up (FU)). The radiographs were analyzed for: 1) navicular-cuboidal-index (NCI); 2) talocalcaneal angle anteroposterior; 3) talocalcaneal angle lateral; 4) calcaneal-pitch (CP); and 5) talometatarsal-index (TMTI). Following this, 25 patients with 38 flatfeet could be included. RESULTS The mean age at SA of the JNF group was 9.2 years (JF group: 9.3 years) and the mean time of FU was 35.2 months (JF group: 39.4 months). In comparison with preoperatively, a significant decrease of the NCI was seen in both groups (p = ≤ 0.05 and p = ≤ 0.001) in the FU radiographs. The analysis of CP and TMTI in the JF group also resulted in a significant improvement (p = ≤ 0.001 and p = ≤ 0.05). Overall, the comparison between the JNF and JF group showed no significant differences in regard to the analyzed postoperative parameters. CONCLUSION Based on this data, treatment of flatfeet by SA in patient with neurological disorders shows an improvement of radiological parameters comparable with neurologically unimpaired patients and might be considered as additional treatment option. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- H. Kubo
- University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Düsseldorf, Germany
| | - R. Krauspe
- University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Düsseldorf, Germany,Correspondence should be sent to Ruediger Krauspe, University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany.
| | - M. Hufeland
- University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Düsseldorf, Germany
| | - C. Lipp
- University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Düsseldorf, Germany
| | - M. Ruppert
- University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Düsseldorf, Germany
| | - B. Westhoff
- University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Düsseldorf, Germany
| | - H. Pilge
- University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Düsseldorf, Germany
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Abstract
In the past few decades, total ankle replacement (TAR) has become an increasingly recommended and accepted treatment in patients with end-stage ankle osteoarthritis. However, controversy still exists about the appropriate indications for TAR, specifically in ankles with coronal plane deformities. Although not explicitly proved, the long-term success of TAR seems to largely depend on the extent to which the surgeon is able to balance the ankle joint complex.
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Affiliation(s)
- Beat Hintermann
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland.
| | - Roxa Ruiz
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland
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Wallroth A, Dreher T. [Components of the joint-sparing, combined bony and soft tissue correction of the cavovarus foot]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2018; 30:286-292. [PMID: 29931378 DOI: 10.1007/s00064-018-0552-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/19/2017] [Accepted: 10/11/2017] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Combined bony and soft tissue correction of a mild foot and flexible rearfoot deformity in cavovarus foot. INDICATIONS Drop foot during swing phase and muscular imbalance in the stance phase in cavovarus foot, flexible cavovarus foot, accompanying symptoms such as recurrent calluses and ulcerations, compliance. CONTRAINDICATIONS Pes cavovarus of spastic genesis, mild deformities, fixed bony deformity, lack of compliance, florid inflammation in the foot area, severe peripheral artery disease (PAD), diabetes mellitus. SURGICAL TECHNIQUE Description of the gradual escalation of joint-sparing bony and soft tissue procedures. POSTOPERATIVE MANAGEMENT Postoperative lower leg cast. In cases of combined bony and soft tissue correction, first 6 weeks of nonweight-bearing with lower leg cast, then 6 weeks of lower leg walking cast. With adequate bony consolidation, cast removal after a total of 12 weeks. In cases of pure soft-tissue foot correction, 6 weeks of lowerleg walking cast. RESULTS It was shown that only 22.5% of the affected feet (40 preoperative patients with cavovarus foot deformity) had a severe hindfoot equinus due to shortened calf muscles. In a study with 14 patients, it was shown that the tibialis posterior tendon transfer corrects the drop foot component and the excessive medial arch of the feet is significantly reduced by combined soft tissue and bony procedures.
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Affiliation(s)
- A Wallroth
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - T Dreher
- Sektion Kinderorthopädie, Neuroorthopädie und Fußchirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Barg A, Ruiz R, Hintermann B. [Triple arthrodesis for correction of cavovarus deformity]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2017; 29:461-472. [PMID: 29052742 DOI: 10.1007/s00064-017-0519-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 07/01/2017] [Accepted: 07/12/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim is to correct the underlying cavovarus deformity and to achieve a pain-free and stable hindfoot. INDICATIONS Rigid neurologic, posttraumatic, congenital, and idiopathic cavovarus deformities. CONTRAINDICATIONS General surgical or anesthesiological risks, infections, critical soft tissue conditions, neurovascular impairment of the lower extremity, noncompliance, patients with severely reduced bone quality, insulin-dependent diabetes mellitus, smoking. SURGICAL TECHNIQUE The talonavicular and subtalar joints are exposed using a single medial approach. Joint cartilage is carefully debrided. Hindfoot reposition with complete correction of cavovarus deformity in all three planes. Joints are stabilized using cannulated screws, followed by wound closure. POSTOPERATIVE MANAGEMENT A soft wound dressing is used. Thromboprophylaxis is recommended. Patient mobilization starts on postoperative day 1 using a stabilizing walking boot or cast for 6 weeks with 15 kg partial weight bearing. Clinical and radiographic follow-up 6 weeks postoperatively to assess osseous consolidation at the arthrodesis site. Following clinical and radiographic follow-up at 6 weeks, full weight bearing is gradually initiated. RESULTS Between January 2012 and July 2014, triple arthrodesis was performed in 11 patients with a mean age of 62 ± 14 years due to cavovarus deformity. The mean follow-up was 34 ± 8 months (range 24-48 months). In all patients, the cavovarus deformity was substantially corrected. Significant pain relief from 7.1 ± 2.2 (range 5-10) to 1.8 ± 1.5 (range 0-4) on the visual analogue scale was observed.
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Affiliation(s)
- A Barg
- Orthopädische Klinik, Universität Utah, 590 Wakara Way, 84108, Salt Lake City, UT, USA.
- Harold K. Dunn Orthopädisches Forschungslabor, Orthopädische Klinik, Universität Utah, Salt Lake City, UT, USA.
| | - R Ruiz
- Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Kantonsspital Baselland, Liestal, Schweiz
| | - B Hintermann
- Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Kantonsspital Baselland, Liestal, Schweiz
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Aseptische Lockerung einer OSG-Endoprothese. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2017; 29:236-252. [DOI: 10.1007/s00064-017-0500-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/29/2016] [Accepted: 11/15/2016] [Indexed: 12/30/2022]
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Pagenstert G, Wimmer MD, Jacxsens M, Saltzman CL, Barg A. [Aseptic loosening of total ankle replacement : One-stage revision ankle arthroplasty]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2017; 29:220-235. [PMID: 28497248 DOI: 10.1007/s00064-017-0497-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 01/16/2017] [Accepted: 03/02/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To revise one or both loosened prosthesis components, to achieve postoperative pain relief, and preserve ankle range of motion. INDICATIONS Aseptic loosening of the tibial and/or talar ankle prosthesis components without substantial bone defect of the tibial or talar bone stock. CONTRAINDICATIONS General surgical or anesthesiological risks, infections, critical soft tissue conditions, nonmanageable hindfoot instability, neurovascular impairment of the lower extremity, neuroarthropathy (e. g. Charcot arthropathy), substantial nonreconstructable osseous defects with or without cysts on the tibial and/or talar side, non-compliance, patients with primary total ankle replacement (TAR) using intramedullary fixation (stem fixation), patients with severely reduced bone quality, insulin-dependent diabetes mellitus, smoking, unrealistic patient expectations, patients with high activity in sports. SURGICAL TECHNIQUE Exposure of the ankle joint using the previous incision (anterior or lateral transfibular approach). Mobilization and removal of loosened prosthesis component. Careful debridement of bone stock at bone-prosthesis interface. Determination of prosthesis component size. Implantation of definitive prosthesis components. Wound closure in layers. POSTOPERATIVE MANAGEMENT A soft wound dressing is used. Thromboprophylaxis is recommended. Patient mobilization starts at postoperative day 1 with 15 kg partial weight bearing using a stabilizing walking boot or cast for 6 weeks. Following clinical and radiographic follow-up at 6 weeks, full weight bearing is initiated gradually. RESULTS Between January 2007 and December 2012 a one-stage revision TAR was performed in 14 patients with a mean age of 52.7 ± 12.0 years (29.8-70.5 years). The indication for revision surgery was aseptic loosening of one or both prosthesis components. The mean time between the initial TAR and revision surgery was 5.9 ± 2.9 years (2.0-11.5 years). In 2 patients a tibiotalocalcaneal arthrodesis was performed due to painful aseptic loosening of revision TAR. In all patients a significant pain relief was observed.
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Affiliation(s)
- G Pagenstert
- Orthopädische Klinik, Universität Basel, Basel, Schweiz
| | - M D Wimmer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - M Jacxsens
- Orthopädische Klinik, Universität Basel, Basel, Schweiz.,Harold K. Dunn Orthopädisches Forschungslabor, Orthopädische Klinik, Universität Utah, Salt Lake City, UT, USA
| | - C L Saltzman
- Orthopädische Klinik, Universität Utah, 590 Wakara Way, 84108, Salt Lake City, UT, USA
| | - A Barg
- Harold K. Dunn Orthopädisches Forschungslabor, Orthopädische Klinik, Universität Utah, Salt Lake City, UT, USA. .,Orthopädische Klinik, Universität Utah, 590 Wakara Way, 84108, Salt Lake City, UT, USA.
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Die perkutane Kalkaneusverschiebeosteotomie. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2016; 28:309-20. [DOI: 10.1007/s00064-016-0459-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/13/2016] [Accepted: 03/15/2016] [Indexed: 11/25/2022]
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