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Mathieu J, Dagneaux L. Midfoot Tarsectomy in Cavovarus: Why PSI Makes a Difference? Foot Ankle Clin 2023; 28:791-803. [PMID: 37863535 DOI: 10.1016/j.fcl.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
The cavovarus foot is a complex deformity that can be treated using multiple surgical procedures, ranging from soft tissue surgery to triple arthrodesis. Among these options, anterior midfoot tarsectomy is a three-dimensional closed-wedge osteotomy, traditionally performed slowly and progressively in a blind fashion, and remaining a challenge for unexperimented surgeons with variable outcomes. As such, we investigated and discussed the use of patient-specific cutting guides (PSCGs) in computer-assisted anterior midfoot tarsectomy in terms of accuracy, reproducibility, and safety.
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Affiliation(s)
- Julie Mathieu
- Department of Orthopedic Surgery, Lower Limb Surgery Unit, Univ Montpellier, 371 av. Gaston Giraud, Montpellier Cedex 05 34295, France
| | - Louis Dagneaux
- Department of Orthopedic Surgery, Lower Limb Surgery Unit, Univ Montpellier, 371 av. Gaston Giraud, Montpellier Cedex 05 34295, France; Laboratoire de mécanique et génie civil (LMGC), CNRS, Montpellier University of Excellence (MUSE), 860, rue de St-Priest, Montpellier 34090, France.
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Chans-Veres J, Albiñana-Cunningham J, Quintela JM, Pereira E, Tejero S. Severe equinus cavo-varus correction through triplanar tarsectomy and posterior tibial tendon transfer based on 3D-printed biomodel. Foot (Edinb) 2023; 54:101976. [PMID: 36806118 DOI: 10.1016/j.foot.2023.101976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
Surgery for severe equine cavo-varus is complex and must be individualized. The interindividual phenotypic variability demands a personalized planning of each foot to be operated. The study's primary goal was to evaluate the function and satisfaction of a series of patients with severe equinus cavo-varus deformity who underwent a triplanar tarsectomy and transposition of the posterior tibial tendon in a single stage surgery after a patient specific 3D biomodel planning. A series of 12 feet (5 patients bilaterally) operated with this technique was analyzed. The cohort comprised 2 females (28.5 %) and 5 males (71.4 %). The median follow-up time was 38.5 months (interquartile range: 24.75-48.75). The Foot and Ankle Disability Index pre (median 32.85; interquartile range: 20-46) and postsurgery (median 72; interquartile range: 56-75.5) were collected and statistically significant differences were observed (p < 0.002). Furthermore, the main variable evaluated was obtaining a plantigrade stable foot. This was clinically evaluated and was achieved in all patients except 1 patient who presented a residual equinus of 5º. This study shows that triplanar tarsectomy and posterior tibial tendon transfer in a single surgical procedure after patient-specific 3D biomodel planning allows for improved function in patients with severe equinus cavus varus foot deformity.
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Affiliation(s)
- Juan Chans-Veres
- Avda Manuel Siurot s/n 41011 (Sevilla), University Hospital Virgen del Rocío, Sevilla, Spain.
| | - Juan Albiñana-Cunningham
- C. de Irunlarrea, 3, 31008 Pamplona, Navarra, Hospital Universitario de Navarra, Pamplona, Spain.
| | | | - Eduardo Pereira
- Av. San Juan de Dios, s/n, 41930 Bormujos (Sevilla), San Juan de Dios Hospital, Sevilla, Spain.
| | - Sergio Tejero
- Avda Manuel Siurot s/n 41011 (Sevilla), Professor Orthopaedic Surgery, University of Sevilla, Spain; Head of Foot Ankle Unit at University Hospital Virgen del Rocío, Sevilla, Spain.
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Hentges M, Pugh E, Gesheff MG, Ernst JJ, Lamm BM. Realignment Midfoot Osteotomy: A Preoperative Planning Method and Intraoperative Surgical Technique. J Foot Ankle Surg 2022; 61:170-174. [PMID: 34257021 DOI: 10.1053/j.jfas.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 10/11/2020] [Accepted: 06/07/2021] [Indexed: 02/03/2023]
Abstract
Deformities of the midfoot are often treated with midfoot osteotomies. The goal of the midfoot osteotomy is to create a plantigrade forefoot to hindfoot relationship. Many different techniques are described for performing midfoot osteotomies. Our goal is to present an objective pre-operative planning method and an intra-operative technique for accurate multiplanar realignment and discuss our short-term results. We retrospectively reviewed 18 patients, 10 female (56%) and 8 male (44%), that underwent realignment midfoot osteotomies. The mean follow-up was 25 months (range, 4-120). The mean age at the time of surgery was 53 years (range, 21-76). Statistically significant improvement in radiographic alignment was found in the anteroposterior talo-first metatarsal angle (p = .002) and the mechanical axis deviation of the foot (p = .02). This study proved that our pre-operative and intra-operative planning technique provides accurate multiplanar radiographic realignment with good clinical results.
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Affiliation(s)
- Matthew Hentges
- Fellowship Trained Foot & Ankle Surgeon, Faculty, Foot and Ankle Surgery Residency Program, Allegheny Health Network, West Penn Hospital, Pittsburgh, PA
| | - Emily Pugh
- Fellowship Trained Foot & Ankle Surgeon, Atrius Health, Boston, MA
| | - Martin G Gesheff
- Research Program Manager, International Center for Limb Lengthening, Rubin Institute or Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Jordan J Ernst
- Deformity Correction Fellow, The Paley Institute at St. Mary's Hospital and Palm Beach Children's Hospital, West Palm Beach, FL
| | - Bradley M Lamm
- Chief, Foot & Ankle Surgery at St. Mary's Medical Center and the Palm Beach Children's Hospital, West Palm Beach, FL; Director, Foot & Ankle Deformity Center & Fellowship at the Paley Orthopedic and Spine Institute, West Palm Beach, FL.
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Abstract
Management of the cavus foot is a difficult task for the foot and ankle surgeon. Tendon transfers have been a longstanding accepted treatment for the flexible cavus foot. Performing tendon transfers requires an in-depth understanding of the patient's medical history, factors leading to the development of deformity, as well as the deforming forces contributing to the deformity. Evaluation of the patient for rigid, progressive, and/or spastic deformities is critical to avoid postoperative complications. Educating the patient on postoperative rehabilitation, potential complications, and postoperative expectations is essential to ensure appropriate surgical outcomes.
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Grady JF, Schumann J, Cormier C, LaViolette K, Chinn A. Management of Midfoot Cavus. Clin Podiatr Med Surg 2021; 38:391-410. [PMID: 34053651 DOI: 10.1016/j.cpm.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is a deficiency in publications on the topic of midfoot cavus. The limited research available does not have a standard definition for the diagnosis of this deformity and lacks a reliable algorithm for its surgical management. The authors performed an extensive review of the literature that found a majority of patients are satisfied with the Cole osteotomy and the dorsiflexory first metatarsal osteotomy for treatment of this condition. High patient satisfaction has been observed with lateralizing calcaneal osteotomies in the setting of midfoot cavus with a secondary rigid rearfoot deformity. Further research on this topic is encouraged.
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Affiliation(s)
- John F Grady
- Podiatric Residencies, Advocate Christ Medical Center and Advocate Children's Hospital, 4650 Southwest Highway, Oak Lawn, IL 60453, USA; Rosalind Franklin University (Adjunct Track), North Chicago, IL, USA; Foot and Ankle Institute of Illinois, 4650 Southwest Highway, Oak Lawn, IL 60453, USA; Foot and Ankle Institute for Research (FAIR), 4650 Southwest Highway, Oak Lawn, IL 60453, USA.
| | - Jaclyn Schumann
- Podiatric Medicine and Surgery Residency Program PGY3, Advocate Christ Medical Center, 4440 West 95th Street, Oak Lawn, IL 60453, USA
| | - Clare Cormier
- Podiatric Medicine and Surgery Residency Program PGY2, Advocate Christ Medical Center, 4440 West 95th Street, Oak Lawn, IL 60453, USA
| | - Kathryn LaViolette
- Podiatric Medicine and Surgery Residency Program Graduate, Advocate Christ Medical Center, 4440 West 95th Street, Oak Lawn, IL 60453, USA
| | - Austin Chinn
- Podiatric Medicine and Surgery Residency Program PGY2, Advocate Christ Medical Center, 4440 West 95th Street, Oak Lawn, IL 60453, USA
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Shapiro J. Surgical Biomechanics: Principles of Procedure Choice. Clin Podiatr Med Surg 2020; 37:101-116. [PMID: 31735262 DOI: 10.1016/j.cpm.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surgical treatment of foot and ankle ailments is common, but in the past the choice of procedures was often dictated principally by positional considerations. This article reviews the use of the 2 primary biomechanical approaches, the kinematic and kinetic methods, and presents a novel unified method to guide surgical procedure choice, the kineticokinematic approach. Decision-making methods and resources are discussed and 2 case studies are presented to elucidate how this method may be used when choosing surgical procedures.
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Affiliation(s)
- Jarrod Shapiro
- Western University of Health Sciences, College of Podiatric Medicine, Department of Podiatric Medicine, Surgery and Biomechanics, Chino Valley Medical Center Podiatric Medicine and Surgery Residency with Rearfoot Reconstruction and Ankle Certificate, 795 East 2nd Street, Suite 7, Pomona, CA 91766, USA.
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Lin T, Gibbons P, Mudge AJ, Cornett KM, Menezes MP, Burns J. Surgical outcomes of cavovarus foot deformity in children with Charcot-Marie-Tooth disease. Neuromuscul Disord 2019; 29:427-436. [DOI: 10.1016/j.nmd.2019.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 04/07/2019] [Accepted: 04/24/2019] [Indexed: 11/27/2022]
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Faldini C, Traina F, Nanni M, Mazzotti A, Calamelli C, Fabbri D, Pungetti C, Giannini S. Surgical treatment of cavus foot in Charcot-Marie-tooth disease: a review of twenty-four cases: AAOS exhibit selection. J Bone Joint Surg Am 2015; 97:e30. [PMID: 25788311 DOI: 10.2106/jbjs.n.00794] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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. Clinical evaluation was summarized with the Maryland Foot Score. Radiographic evaluation assessed calcaneal pitch, Meary angle, Hibb angle, and absence of degenerative joint changes. Only patients who had a flexible deformity, with varus of the heel reducible in the Coleman-Andreasi test, and did not have degenerative joint arthritis were included in this study. Surgical treatment consisted in plantar fasciotomy, midtarsal osteotomy, extensor hallucis longus tendon transfer to the first metatarsal (Jones procedure), and dorsiflexion osteotomy of the first metatarsal. Mean follow-up was six years (range, two to thirteen years). The mean Maryland Foot Score was 72 preoperatively and 86 postoperatively. The postoperative result was rated as excellent in twelve feet (50%), good in ten (42%), and fair in two (8%). Mean calcaneal pitch was 34° preoperatively and 24° at the time of the latest follow-up, the mean Hibb angle was 121° preoperatively and 136° postoperatively, and the mean Meary angle was 25° preoperatively and 2° postoperatively. Plantar fasciotomy, midtarsal osteotomy, the Jones procedure, and dorsiflexion osteotomy of the first metatarsal yielded adequate correction of flexible cavus feet in patients with Charcot-Marie-Tooth disease in the absence of fixed hindfoot deformity. The fact that the improvement in the outcome score was only modest may be attributable to the lack of motor balance.
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Affiliation(s)
- Cesare Faldini
- University of Bologna, via Zamboni 33, 40126 Bologna, Italy. E-mail address for C. Faldini:
| | - Francesco Traina
- Department of Orthopaedics and Trauma Surgery, Rizzoli Orthopaedic Institute, via G.C. Pupilli 1, 40136 Bologna, Italy
| | - Matteo Nanni
- Department of Orthopaedics and Trauma Surgery, Rizzoli Orthopaedic Institute, via G.C. Pupilli 1, 40136 Bologna, Italy
| | - Antonio Mazzotti
- University of Bologna, via Zamboni 33, 40126 Bologna, Italy. E-mail address for C. Faldini:
| | - Carlotta Calamelli
- University of Bologna, via Zamboni 33, 40126 Bologna, Italy. E-mail address for C. Faldini:
| | - Daniele Fabbri
- University of Bologna, via Zamboni 33, 40126 Bologna, Italy. E-mail address for C. Faldini:
| | - Camilla Pungetti
- University of Bologna, via Zamboni 33, 40126 Bologna, Italy. E-mail address for C. Faldini:
| | - Sandro Giannini
- University of Bologna, via Zamboni 33, 40126 Bologna, Italy. E-mail address for C. Faldini:
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Abstract
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.
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Affiliation(s)
- Dennis S Weiner
- Department of Pediatric Orthopaedic Surgery, Children's Hospital Medical Center of Akron, 300 Locust Street, Suite 160, Akron, OH 44302, USA.
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Skalsky AJ, McDonald CM. Prevention and management of limb contractures in neuromuscular diseases. Phys Med Rehabil Clin N Am 2013; 23:675-87. [PMID: 22938881 DOI: 10.1016/j.pmr.2012.06.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Limb contractures are a common impairment in neuromuscular diseases. They contribute to increased disability from decreased motor performance, mobility limitations, reduced functional range of motion, loss of function for activities of daily living, and increased pain. The pathogenesis of contractures is multifactorial. Myopathic conditions are associated with more severe limb contractures compared with neuropathic disorders. Although the evidence supporting the efficacy of multiple interventions to improve range of motion in neuromuscular diseases in a sustained manner is lacking, there are generally accepted principles with regard to splinting, bracing, stretching, and surgery that help minimize the impact or disability from contractures.
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Affiliation(s)
- Andrew J Skalsky
- Rady Children's Hospital, Division of Pediatric Rehabilitation, MC 5096, 3020 Children's Way, University of California San Diego School of Medicine, San Diego, CA 92123, USA
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Abstract
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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Affiliation(s)
- Protyush Chatterjee
- Department of Orthopaedics and Rehabilitation, Rehabilitation Centre for Children, 59, Motilal Gupta Road, Calcutta - 700 008, India,Address for correspondence: Dr. Protyush Chatterjee, H 4/4, Labony Estate, Salt Lake, Calcutta - 700 064. India. E-mail:
| | - M K Sahu
- Department of Orthopaedics and Rehabilitation, Rehabilitation Centre for Children, 59, Motilal Gupta Road, Calcutta - 700 008, India
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