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An TW, Berke G, Beattie W, Chan JY. Orthotic Devices for the Foot and Ankle. J Am Acad Orthop Surg 2024; 32:e795-e806. [PMID: 38109744 DOI: 10.5435/jaaos-d-23-00832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023] Open
Abstract
Millions of Americans wear ankle-foot orthotic devices for protection, pain relief, and deformity correction. Inquiries about off-the-shelf and custom devices are a common reason for evaluation with a foot and ankle surgeon or general orthopaedic surgeon. Despite limited high-quality evidence for their use, these devices can have a notable clinical impact on physical function. An up-to-date understanding of orthotic device options and their appropriate use in managing musculoskeletal pathologies applies to all orthopaedic providers. This review aims to categorize orthosis types and provide specific device recommendations for common adult conditions such as flatfoot, cavovarus foot, and ankle instability. Collaboration with a certified orthotist can help patients achieve functional and recreational goals with the use of appropriately designed and applied orthoses.
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Affiliation(s)
- Tonya W An
- From the Department of Orthopaedic Surgery, Stanford University, Stanford, CA (An, Berke, and Chan) and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, IL (Beattie)
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Laurá M, Barnett J, Benfield J, Ramdharry GM, Welck MJ. Foot surgery for adults with Charcot-Marie-Tooth disease. Pract Neurol 2024; 24:275-284. [PMID: 38631902 DOI: 10.1136/pn-2023-003825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
People with Charcot-Marie-Tooth (CMT) disease often undergo foot and ankle surgery, as foot deformities are common and cause a degree of functional limitations impairing quality of life. Surgical approaches are variable and there are no evidence-based guidelines. A multidisciplinary approach involving neurology, physical therapy and orthopaedic surgery is ideal to provide guidance on when to refer for surgical opinion and when to intervene. This review outlines the range of foot deformities associated with CMT, their clinical assessment, and their conservative and surgical and postoperative management.
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Affiliation(s)
- Matilde Laurá
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - James Barnett
- Foot & Ankle Unit, Royal National Orthopaedic Hospital Stanmore Site, Stanmore, UK
| | - Joanna Benfield
- Foot & Ankle Unit, Royal National Orthopaedic Hospital Stanmore Site, Stanmore, UK
| | - Gita M Ramdharry
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Matthew J Welck
- Foot & Ankle Unit, Royal National Orthopaedic Hospital Stanmore Site, Stanmore, UK
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Aslam MS, Kim YJ, Qian L. A Retrospective Bayesian Design of Experiment (B-DOE) on Drug Reposition Candidates for Treatment of Charcot-Marie-Tooth Neuropathy. MULTIDISCIPLINARY APPLICATIONS OF NATURAL SCIENCE FOR DRUG DISCOVERY AND INTEGRATIVE MEDICINE 2023:275-290. [DOI: 10.4018/978-1-6684-9463-9.ch008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Bayesian design of experiment (B-DOE) uses the principle of Bayesian Epistemology that explain the evidence as a logical-probalistic coherence on the basis of rational degrees of belief (or degrees of confidence). The researcher has design the (B-DOE) using Multilevel Hierarchy (MH), and data that may be obtained at the weak to moderate evidence level (literature, biological. Mechanism, computational and retrospective) may be helpful to identify bioactive compounds for treating (CMT) and provide the knowledge on pathogenesis, prognostic of the disease and collective mechanism of drug of action. The investigators will classify the evidence on the basis of hierarchy as moderate and weak, which will ultimately help to study new promising bioactive compounds potentially able to solve some of the issues related to CMT.
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Affiliation(s)
| | - Yun Jin Kim
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Malaysia
| | - Linchao Qian
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Malaysia
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Waldman LE, Michalski MP, Giaconi JC, Pfeffer GB, Learch TJ. Charcot-Marie-Tooth Disease of the Foot and Ankle: Imaging Features and Pathophysiology. Radiographics 2023; 43:e220114. [PMID: 36862083 DOI: 10.1148/rg.220114] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Charcot-Marie-Tooth disease (CMT) is the most common inherited peripheral polyneuropathy, resulting in length-dependent motor and sensory deficiencies. Asymmetric nerve involvement in the lower extremities creates a muscle imbalance, which manifests as a characteristic cavovarus deformity of the foot and ankle. This deformity is widely considered to be the most debilitating symptom of the disease, causing the patient to feel unstable and limiting mobility. Foot and ankle imaging in patients with CMT is critical for evaluation and treatment, as there is a wide range of phenotypic variation. Both radiography and weight-bearing CT should be used for assessment of this complex rotational deformity. Multimodality imaging including MRI and US is also important to help identify changes in the peripheral nerves, diagnose complications of abnormal alignment, and evaluate patients in the perioperative setting. The cavovarus foot is susceptible to distinctive pathologic conditions including soft-tissue calluses and ulceration, fractures of the fifth metatarsal, peroneal tendinopathy, and accelerated arthrosis of the tibiotalar joint. An externally applied brace can assist with balance and distribution of weight but may be appropriate for only a subset of patients. Many patients will require surgical correction, which may include soft-tissue releases, tendon transfers, osteotomies, and arthrodesis when necessary, with the goal of creating a more stable plantigrade foot. The authors focus on the cavovarus deformity of CMT. However, much of the information discussed may also be applied to a similar deformity that may result from idiopathic causes or other neuromuscular conditions. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Leah E Waldman
- From the Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27705 (L.E.W.); and Departments of Orthopedic Surgery (M.P.M., G.B.P.) and Radiology (J.C.G., T.J.L.), Cedars Sinai Medical Center, Los Angeles, Calif
| | - Max P Michalski
- From the Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27705 (L.E.W.); and Departments of Orthopedic Surgery (M.P.M., G.B.P.) and Radiology (J.C.G., T.J.L.), Cedars Sinai Medical Center, Los Angeles, Calif
| | - Joseph C Giaconi
- From the Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27705 (L.E.W.); and Departments of Orthopedic Surgery (M.P.M., G.B.P.) and Radiology (J.C.G., T.J.L.), Cedars Sinai Medical Center, Los Angeles, Calif
| | - Glenn B Pfeffer
- From the Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27705 (L.E.W.); and Departments of Orthopedic Surgery (M.P.M., G.B.P.) and Radiology (J.C.G., T.J.L.), Cedars Sinai Medical Center, Los Angeles, Calif
| | - Thomas J Learch
- From the Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27705 (L.E.W.); and Departments of Orthopedic Surgery (M.P.M., G.B.P.) and Radiology (J.C.G., T.J.L.), Cedars Sinai Medical Center, Los Angeles, Calif
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Wenz W. Double and Triple Tarsal Fusions in the Complex Cavovarus Foot. Foot Ankle Clin 2022; 27:819-833. [PMID: 36368799 DOI: 10.1016/j.fcl.2022.08.004] [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] [Indexed: 11/09/2022]
Abstract
The cavovarus (cavus) foot is one of the most perplexing and challenging of all foot deformities and may prove to be one of the most difficult conditions to treat. This deformity is characterized by increased plantar flexion of the forefoot and midfoot in relation to the hindfoot resulting in high foot arch. Because cavus foot rarely occurs in an isolated form, the term "cavus foot" rather describes a part of a complex multiplanar foot deformity. Because the underlying disease is mostly neurogenic characterized by muscle imbalance in almost every case a combined bony and soft tissue surgery is inevitable.
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Affiliation(s)
- Wolfram Wenz
- EXPERTS FIRST Die Knochen-Docs, Rudolf-Diesel-Straße 11, Heidelberg 69115, Germany.
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Warner WC. Orthopedic Surgery in Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yan Z, Chen D, Yao L, Wang C, Ran X. Diabetes coexistent with Charcot-Marie-Tooth disease presenting as a recurrent foot ulcer misdiagnosed as diabetic foot: A case report. J Diabetes Investig 2021; 12:2099-2101. [PMID: 33991180 PMCID: PMC8565404 DOI: 10.1111/jdi.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 02/05/2023] Open
Abstract
Both diabetes mellitus and Charcot-Marie-Tooth disease (CMT) can lead to severe peripheral neuropathy. The differential diagnosis of peripheral neuropathy is difficult due to the similar clinical features. There are still some clues, such as unusual muscle atrophy, unmatched severity of peripheral neurogenic damage with nephropathy or retinopathy, which could alert clinicians to make differential diagnosis. Although diabetes mellitus is rarely concurrent with CMT, it will exacerbate clinical disorders in patients with CMT. To date, there is no specific medicine for CMT treatment. Offloading devices and desirable comprehensive management of diabetes mellitus might be beneficial to avoid plantar ulcer recurrence and anti-progression of CMT.
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Affiliation(s)
- Zhe Yan
- Innovation Center for Wound RepairDiabetic Foot Care CenterDepartment of Endocrinology and MetabolismWest China HospitalSichuan UniversityChengduChina
| | - Dawei Chen
- Innovation Center for Wound RepairDiabetic Foot Care CenterDepartment of Endocrinology and MetabolismWest China HospitalSichuan UniversityChengduChina
| | - Li Yao
- Department of RadiologyWest China HospitalSichuan UniversityChengduChina
| | - Chun Wang
- Innovation Center for Wound RepairDiabetic Foot Care CenterDepartment of Endocrinology and MetabolismWest China HospitalSichuan UniversityChengduChina
| | - Xing‐Wu Ran
- Innovation Center for Wound RepairDiabetic Foot Care CenterDepartment of Endocrinology and MetabolismWest China HospitalSichuan UniversityChengduChina
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Jordà-Gómez P, Sánchez-Gonzalez M, Ortega-Yago A, Navarrete-Faubel E, Martínez-Garrido I, Vicent-Carsí V. Management of flexible cavovarus foot in patients with Charcot-Marie-Tooth disease: Midterm results. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Jacobs AM. Pes Cavus Deformity: Anatomic, Functional Considerations, and Surgical Implications. Clin Podiatr Med Surg 2021; 38:291-302. [PMID: 34053645 DOI: 10.1016/j.cpm.2020.12.012] [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: 11/25/2022]
Abstract
Pes cavus is a complicated, multiplanar deformity that requires a thorough understanding in order to provide the appropriate level of care. The foot and ankle surgeon should perform a comprehensive examination, including a neurologic evaluation, in the workup of this patient population. Understanding the cause of the patient's deformity is a critical step in predicting the disease course as well as the most acceptable form of treatment. The surgical correlation with the patient's pathologic anatomy requires an in-depth clinical evaluation, in addition to the radiographic findings, as the radiographic findings do not necessarily correlate with the patient's discomfort.
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Affiliation(s)
- Allen Mark Jacobs
- Foot and Ankle Surgery Residency, SSM Health DePaul Hospital, St Louis, MO 63117, USA.
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Wolfe JR, McKee TD, Nicholes M. Use of Calcaneal Osteotomies in the Correction of Inframalleolar Cavovarus Deformity. Clin Podiatr Med Surg 2021; 38:379-389. [PMID: 34053650 DOI: 10.1016/j.cpm.2021.03.002] [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: 10/21/2022]
Abstract
Cavovarus deformity is a complicated condition most commonly resulting from neurologic, posttraumatic, or iatrogenic pathologic conditions. Careful evaluation of the cavovarus patient is necessary in determining appropriate treatment course. Weight-bearing radiographs are necessary, and advances in computed tomographic technology can be beneficial in identifying level of involvement. In the case of operative treatment of inframalleolar deformity, assessment of the subtalar joint position and relation of calcaneocuboid joint can be of assistance. Multiple osteotomies have been described providing uniplanar, biplanar, and triplanar correction and in the appropriate setting can prove beneficial to the surgeon in treating hind-foot cavovarus deformity.
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Affiliation(s)
- Jesse R Wolfe
- Northwest Iowa Bone, Joint, & Sports Surgeons, 1200 1st Avenue E, Suite C, Spencer, IA 51301, USA.
| | - Tyler D McKee
- American Health Network Foot & Ankle Reconstructive Surgery Fellowship, 12188B North Meridian Street, Suite #330, Carmel, IN 46032, USA
| | - Melinda Nicholes
- SSM Health DePaul Hospital Foot and Ankle Surgery Residency, St Louis, MO, USA; SSM Health DePaul Hospital, 12303 DePaul Drive, Bridgeton, MO 63044, USA
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Sanpera I, Villafranca-Solano S, Muñoz-Lopez C, Sanpera-Iglesias J. How to manage pes cavus in children and adolescents? EFORT Open Rev 2021; 6:510-517. [PMID: 34267941 PMCID: PMC8246104 DOI: 10.1302/2058-5241.6.210021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pes cavus in its different forms is not a pathological entity, but rather the manifestation of multiple diseases. Cavovarus, a form of cavus foot, should never be considered a physiological deformity. A neurological condition should always be excluded. The evolution of pes cavovarus is unpredictable because of the large number of conditions involved in its aetiology, as well as their variable degree of expression. About 66% of cavovarus feet are the result of subtle neurological diseases, which only become evident later in life. Although surgery may not change quality of life, recent studies suggest that it may improve foot posture and reduce walking instability. The aim of treatment is to preserve a painless, plantigrade, mobile foot. Management consists of correcting bone deformity while preserving movement, and the wise use of rebalancing techniques. Arthrodesis should only be a salvage procedure.
Cite this article: EFORT Open Rev 2021;6:510-517. DOI: 10.1302/2058-5241.6.210021
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Affiliation(s)
- Ignacio Sanpera
- Hospital Universitary Son Espases, Palma de Mallorca, Illes BalearsSpain
| | | | - Carmen Muñoz-Lopez
- Hospital Universitary Son Espases, Palma de Mallorca, Illes BalearsSpain
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Management of flexible cavovarus foot in patients with Charcot-Marie-Tooth disease: midterm results. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [PMID: 33906827 DOI: 10.1016/j.recot.2020.12.002] [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: 11/20/2022] Open
Abstract
INTRODUCTION Charcot-Marie-Tooth disease (CMT) is a hereditary motor sensory neuropathy that frequently results in a cavovarus foot in the adult. Surgical treatment allows correction of the deformity while preserving an adequate range of motion. OBJECTIVE The objective of this study was to assess the result of posterior tibial tendon transfer, first metatarsal ascent osteotomy, and calcaneal valgus osteotomy in the treatment of cavovarus foot secondary to CMT. MATERIAL AND METHODS Retrospective cohort of CMT patients who received surgical treatment of their cavovarus foot. Collected data included demographics, CMT genetic variant, neurologic involvement, surgical technique, range of motion, functionality, radiology, and postoperative satisfaction. RESULTS 16 patients met the inclusion criteria, mostly women (62.5%) with the CMT1A variant (62.5%), and a mean age of 39.5 years. 13 patients required additional surgical techniques: lengthening of the Achilles tendon, interphalangeal arthrodesis and/or plantar fascia section. 2 patients underwent a secondary procedure: subtalar arthrodesis due to persistence of the varus deformity, and a lengthening of the extensor hallux longus due to initial undercorrection. The mean follow-up was 42 months. Significant differences (p = 0.003) were observed between the pre-surgical AOFAS and at 12 months postoperatively (37.25 vs. 86.5). 75% of the patients reported «excellent» or «good» satisfaction after surgery. All radiographic parameters showed significant improvement. CONCLUSIONS The combination of the aforementioned surgical techniques for the cavovarus foot in CMT results in adequate functionality, good radiological correction and a high degree of satisfaction, avoiding primary arthrodescent surgery.
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Vaeth S, Andersen H, Christensen R, Jensen UB. A Search for Undiagnosed Charcot-Marie-Tooth Disease Among Patients Registered with Unspecified Polyneuropathy in the Danish National Patient Registry. Clin Epidemiol 2021; 13:113-120. [PMID: 33623438 PMCID: PMC7896779 DOI: 10.2147/clep.s292676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/09/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose In a recent study based on data from the Danish National Patients Registry (DNPR), we reported the prevalence of Charcot-Marie-Tooth disease (CMT) in Denmark to be 22.5 per 100.000. This prevalence is most likely a minimum estimate, as many cases of CMT may be misdiagnosed or remain undiagnosed due to the heterogeneous nature of the disorder. The aim of this study was to investigate the possible number of undiagnosed CMT cases among patients registered with unspecified polyneuropathy (UP) diagnoses in the DNPR. Patients and Methods From the DNPR we extracted data on all patients given an UP diagnosis in the period 1977 to 2012. We selected all patients diagnosed with a primary UP diagnosis before age 40 at a department of neurology, neurophysiology, clinical genetics or pediatrics, and excluded all patients with a specified polyneuropathy diagnosis or with diagnostic codes related to alcohol and diabetes mellitus. To assess the proportion of possible CMT patients, we performed medical record review in a random sample of patients diagnosed in the Central Denmark Region. To further investigate the possible overlap between UP and CMT in the DNPR, we performed a series of searches for ICD-8 and ICD-10 codes related to CMT. Results Between 1977 and 2012, 30.903 patients were diagnosed with UP without also being diagnosed with CMT. A total of 940 patients fulfilled the selection criteria. We found that 21.5% (95% CI 13.1%–32.2%) of the cases in the random sample fulfilled our criteria for CMT. This estimate increases the prevalence of CMT in Denmark with 3.6 per 100,000 (95% CI 2.4%–5.5%). Conclusion This study illustrates how hitherto undiagnosed CMT patients may be identified in the DNPR and further reports the number of possible CMT cases. Our results support the hypothesis that the true prevalence of CMT is higher than recently reported.
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Affiliation(s)
- Signe Vaeth
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark
| | - Rikke Christensen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark
| | - Uffe Birk Jensen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark
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The diagnosis and management of common childhood orthopedic disorders: An update. Curr Probl Pediatr Adolesc Health Care 2020; 50:100884. [PMID: 33069588 DOI: 10.1016/j.cppeds.2020.100884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Musculoskeletal illness represents a significant portion of office visits to primary and urgent care clinicians. Despite this, little emphasis is placed on learning pediatric orthopaedics during medical school or residency. The focus of this paper is to provide a systematic approach to this general musculoskeletal physical exam and to assist in the recognition of what conditions are normal development and what conditions require observation, workup and referral to an experienced pediatric orthopaedist.
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Böhm H, Döderlein L, Fujak A, Dussa CU. Is there a correlation between static radiographs and dynamic foot function in pediatric foot deformities? Foot Ankle Surg 2020; 26:801-809. [PMID: 31694790 DOI: 10.1016/j.fas.2019.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 06/04/2019] [Accepted: 10/21/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Idiopathic flexible flatfeet, congenital clubfeet and pes cavovarus are the most common foot deformities in children. Accurate assessment to quantify the severity of these deformities by clinical examination alone can be challenging. Radiographs are a valuable adjunct for accurate diagnosis and effective treatment. However, static radiographs during relaxed standing may not reflect the dynamic changes in the foot skeleton during functional activities such as walking. Therefore, the aim of this study is to predict dynamic foot movements during walking from planar standing radiographs to reveal the significance of the radiographic analysis for the assessment of foot function. METHODS Patients 8-17 years with flexible flatfeet (FFF, n=217) recurrent clubfeet (RCF n=38) and overcorrected clubfeet (OCCF, n=71) of non-neurogenic or syndromic origin and pes cavovarus due to peripheral neuropathy (PNP, n=48) were retrospectively included. Patients underwent gait analysis with the Oxford Foot Model and radiographic examination in anterior-posterior and lateral view during standing. Multilinear predictor analysis of selected gait parameters was performed based on radiographic measures. RESULTS The variance that was explained by radiography was greatest for the transverse plane forefoot abduction with 33% for OCCF, 50% for RCF and 59% for PNP. Flatfeet and foot kinematics in the other planes or between rearfoot and tibia showed little or no relation. CONCLUSIONS The static measures of foot deformities by radiography could explain only a small amount of variance in foot kinematics during walking, in particular for FFF. An explanation may be that the forces during weight bearing bear little resemblance to those during gait in terms of neither magnitude nor direction. These findings suggest that foot function cannot be accurately assessed solely from static radiographic observations of the foot, commonly undertaken in clinical practice.
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Affiliation(s)
- Harald Böhm
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau gGmbH, Bernauer str. 18, 83229 Aschau i. Chiemgau, Germany.
| | | | - Albert Fujak
- Friedrich-Alexander-University of Erlangen-Nürnberg, Department of Orthopaedic Surgery Rathsberger str. 57, 91054 Erlangen, Germany
| | - Chakravarty U Dussa
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau gGmbH, Bernauer str. 18, 83229 Aschau i. Chiemgau, Germany; Friedrich-Alexander-University of Erlangen-Nürnberg, Department of Orthopaedic Surgery Rathsberger str. 57, 91054 Erlangen, Germany
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Chen ZY, Wu ZY, An YH, Dong LF, He J, Chen R. Soft tissue release combined with joint-sparing osteotomy for treatment of cavovarus foot deformity in older children: Analysis of 21 cases. World J Clin Cases 2019; 7:3208-3216. [PMID: 31667171 PMCID: PMC6819307 DOI: 10.12998/wjcc.v7.i20.3208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/02/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cavovarus foot is a common form of foot deformity in children, which is clinically characterized by an abnormal increase of the longitudinal arch of the foot, and it can be simultaneously complicated with forefoot pronation and varus, rearfoot varus, Achilles tendon contracture, or cock-up toe deformity. Muscle force imbalance is the primary cause of such deformity. Many diseases can lead to muscle force imbalance, such as tethered cord syndrome, cerebral palsy, Charcot-Marie-Tooth disease, and trauma. At present, many surgical treatments are available for cavovarus foot. For older children, priority should be given to midfoot osteotomy and fusion. Since complications such as abnormal foot length, foot stiffness, and abnormal gait tend to develop postoperatively, it is important to preserve the joints and correct the deformity as much as possible. Adequate soft tissue release and muscle balance are the keys to correcting the deformity and avoiding its postoperative recurrence.
AIM To assess the efficacy of soft tissue release combined with joint-sparing osteotomy in the treatment of cavovarus foot deformity in older children.
METHODS The clinical data of 21 older children with cavovarus foot deformity (28 feet) who were treated surgically at the Ninth Department of Orthopedics of Jizhong Energy Xingtai Mining Group General Hospital from November 2014 to July 2017 were retrospectively analyzed. The patients ranged in age from 10 to 14 years old, with an average age of 12.46 ± 1.20 years. Their main clinical manifestations were deformity, pain, and gait abnormality. The patients underwent magnetic resonance imaging of the lumbar spine, electromyographic examination, weight-bearing anteroposterior and lateral X-rays of the feet, and the Coleman block test. Surgical procedures including metatarsal fascia release, Achilles tendon or medial gastrocnemius lengthening, "V"-shaped osteotomy on the dorsal side of the metatarsal base, opening medial cuneiform wedge osteotomy, closing cuboid osteotomy, anterior transfer of the posterior tibial tendon, peroneus longus-to-brevis transfer, and calcaneal sliding osteotomy to correct hindfoot varus deformity were performed. After surgery, long leg plaster casts were applied, the plaster casts were removed 6 wk later, Kirschner wires were removed, and functional exercise was initiated. The patients began weight-bearing walk 3 mo after surgery. Therapeutic effects were evaluated using the Wicart grading system, and Meary’s angles and Hibbs’ angles were measured based on X-ray images obtained preoperatively and at last follow-up to assess their changes.
RESULTS The patients were followed for 6 to 32 mo, with an average follow-up period of 17.68 ± 6.290 mo. Bone healing at the osteotomy site was achieved at 3 mo in all cases. According to the Wicart grading system, very good results were achieved in 18 feet, good in 7, and fair in 3, with a very good/good rate of 89.3%. At last follow-up, mean Meary’s angle was 6.36° ± 1.810°, and mean Hibbs’ angle was 160.21° ± 4.167°, both of which were significantly improved compared with preoperative values (24.11° ± 2.948° and 135.86° ± 5.345°, respectively; P < 0.001 for both). No complications such as infection, skin necrosis, or bone nonunion occurred.
CONCLUSION Soft tissue release combined with joint-sparing osteotomy has appreciated efficacy in the treatment of cavovarus foot deformity in older children.
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Affiliation(s)
- Zhen-Yu Chen
- The Ninth Department of Orthopedics, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai 054000, Hebei Province, China
| | - Zhan-Yong Wu
- The Ninth Department of Orthopedics, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai 054000, Hebei Province, China
| | - Yue-Hui An
- The Ninth Department of Orthopedics, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai 054000, Hebei Province, China
| | - Li-Fei Dong
- The Ninth Department of Orthopedics, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai 054000, Hebei Province, China
| | - Jia He
- The Ninth Department of Orthopedics, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai 054000, Hebei Province, China
| | - Run Chen
- The Ninth Department of Orthopedics, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai 054000, Hebei Province, China
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Abstract
The purpose of the clinical examination is to detect subtle cavus or cavovarus deformity, assess the severity and type of deformity, differentiate between idiopathic versus secondary etiologies of cavus foot deformity, and evaluate for other associated abnormalities. The clinical examination should begin with a gait analysis. The neurologic examination reveals peripheral neuropathy or central nervous system etiology for the foot deformity. On plain radiographs, forefoot-driven deformity can be assessed using the Meary angle, and hindfoot-driven deformity can be measured by the calcaneal pitch. Computed tomography and MRI scans can assess for tarsal coalitions and soft tissue pathologies, respectively.
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Affiliation(s)
- Craig C Akoh
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health Madison, 600 Highland Avenue, Room 6220, Madison, WI 53705-2281, USA.
| | - Phinit Phisitkul
- Tri-State Specialists, LLP, 2730 Pierce Street, Suite 300, Sioux City, IA 51104, USA
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Stino AM, Atway S, Anthony M, Kline D, Kissel JT. Foot measures in patients with pes cavus with and without charcot-marie-tooth disease: A pilot study. Muscle Nerve 2018; 59:122-125. [PMID: 30039580 DOI: 10.1002/mus.26309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Pes cavus often signals the presence of Charcot-Marie-Tooth (CMT) in adult patients, although its prevalence in the general population makes it a finding of unclear significance. METHODS We undertook a pilot double cohort study to investigate the feasibility of comparing preselected bedside and radiographic foot measures in pes cavus patients with and without CMT. RESULTS A total of 16 CMT and 11 non-CMT patients were recruited. Although no findings consistently met statistical significance, recruitment was highly limiting. CONCLUSIONS Formalized foot measurement comparisons of CMT and non-CMT pes cavus are feasible. Larger studies will be necessary to determine if there are differences in foot structure based on the presence of a hereditary neuropathy. Muscle Nerve 59:122-125, 2019.
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Affiliation(s)
- Amro M Stino
- Ohio State University Wexner Medical Center Department of Neurology, Division of Neuromuscular Medicine, Columbus, Ohio, USA
| | - Said Atway
- Ohio State University Wexner Medical Center Department of Podiatry, Columbus, Ohio, USA
| | - Michael Anthony
- Ohio State University Wexner Medical Center Department of Podiatry, Columbus, Ohio, USA
| | - David Kline
- Ohio State College of Medicine Department of Biomedical Informatics Center for Biostatistics, Columbus, Ohio, USA
| | - John T Kissel
- Ohio State University Wexner Medical Center Department of Neurology, Division of Neuromuscular Medicine, Columbus, Ohio, USA
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19
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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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20
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Abstract
Cavus foot ranges from flexible subtle to rigid severe deformities, and is related to many pathological conditions of the foot and ankle. Understanding the deformity and the deforming force is essential in treating the cavus foot as well as the associated comorbidities. Since every deformity is different, surgical plans should be customized to each patient.
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Affiliation(s)
- Bom Soo Kim
- Department of Orthopaedic Surgery, Inha University College of Medicine 7-241, Sinheung-dong 3-ga, Jung-gu, Incheon 400-712, Republic of Korea
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21
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Dreher T, Beckmann NA, Wenz W. Surgical Treatment of Severe Cavovarus Foot Deformity in Charcot-Marie-Tooth Disease. JBJS Essent Surg Tech 2015; 5:e11. [PMID: 30473919 PMCID: PMC6221429 DOI: 10.2106/jbjs.st.n.00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction A successful adjusted treatment algorithm for the correction of cavovarus foot deformity requires soft-tissue balancing procedures, in particular total split posterior tibial tendon transfer (T-SPOTT), in combination with adjunctive corrective procedures depending on the degree of deformity. Step 1: Surgical Preparation Place the patient in a supine position and follow a standard aseptic surgical disinfection and draping protocol, allowing access to the iliac crest. Step 2: Steindler Release of the Plantar Aponeurosis Use a medial approach to access and transect the plantar aponeurosis. Step 3: Release the Posterior Tibial Tendon at the Foot Transect the posterior tibial tendon near its insertion point. Step 4: Retract and Split the Posterior Tibial Tendon at the Calf and Transfer It Through the Interosseous Membrane Make a medial incision in the distal part of the calf, retract the posterior tibial tendon (and flexor digitorum tendon if necessary), split it longitudinally in half, and pass it through the interosseous space. Step 5: Reveal the Target Tendons and Pull the Posterior-Tibial-Tendon Halves to These Tendons Expose the anterior tibial and peroneal tendons and pull the posterior-tibial-tendon halves (and flexor digitorum longus tendon of it is being used) to these tendons. Step 6: Chopart, or Triple or Lambrinudi, Arthrodesis Perform a Chopart, or triple or Lambrinudi16, arthrodesis when osseous correction and stabilization are required for fixed deformities. Step 7: Modified Jones Procedure If the cavovarus foot displays flexible clawing of the big toe, carry out a modified Jones procedure. Step 8: Extension Osteotomy of the First Metatarsal If the first metatarsal remains in a fixed plantar flexed position and cannot be corrected with the Jones procedure, perform a dorsal-based wedge extension osteotomy. Step 9: Clawing of the Lesser Toes Incise the plantar tendons, transect the long flexor tendons, and place a single Hohmann wire through the end of each claw toe. Step 10: Soft-Tissue Equinus Correction (Rarely Needed) Depending on the severity of the remaining equinus, correct it with calf muscle or calcaneal tendon lengthening (the more severe the equinus, the more distal the corrective measure). Step 11: Supramalleolar Varus Derotation Osteotomy If foot external rotation is increased after foot correction, supramalleolar derotation osteotomy should be added to avoid lever-arm problems postoperatively. Step 12: Complete the Tendon Transfers Attach the transferred tendons to their respective target tendons using a Pulvertaft needle with a Pulvertaft weave technique, while keeping the foot in a plantigrade position. Step 13: Wound Closure Reevaluate the foot and determine if all corrections have been made, perform necessary final radiographic documentation, release the tourniquet, perform hemostasis, clean the wounds, and close them. Step 14: Postoperative Management and Aftercare The achieved operative correction is only as good as the postoperative treatment allows. Results Various authors have recommended posterior tibial tendon transfer to the dorsum of the foot to correct foot drop. Indications Contraindications Pitfalls & Challenges
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Affiliation(s)
- Thomas Dreher
- Division of Paediatric Orthopaedics and Foot Surgery, Department of Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Nicholas A Beckmann
- Division of Paediatric Orthopaedics and Foot Surgery, Department of Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Wolfram Wenz
- Foot Surgery and Pediatric Orthopaedics, ATOS Clinic Heidelberg, Bismarckstraße 9-15, 69115 Heidelberg, Germany
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22
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Abstract
Heritable diseases of the peripheral nerves (Charcot-Marie-Tooth disease [CMT]) affect the motor units and sensory nerves, and they are among the most prevalent genetic conditions in the pediatric patient population. The typical clinical presentation includes distal muscle weakness and atrophy, but the severity and progression are largely variable. Improvements in supportive treatment have led to better preservation of patients' motor functions. More than 80 genes have been associated with CMT. These genetic discoveries, along with the developments of cellular and transgenic disease models, have allowed clinicians to better understand the disease mechanisms, which should lead to more specific treatments.
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Affiliation(s)
- Agnes Jani-Acsadi
- Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Sylvia Ounpuu
- Department of Orthopedic Surgery, Connecticut Children's Medical Center, Farmington, CT, USA
| | - Kristan Pierz
- Department of Orthopedic Surgery, Center of Motion Analysis, Connecticut Children's Medical Center, Farmington, CT, USA
| | - Gyula Acsadi
- Division of Neurology, Department of Neurology, Connecticut Children's Medical Center, University of Connecticut School of Medicine, 505 Farmington Avenue, Farmington, CT 06032, USA.
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23
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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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24
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Dreher T, Wolf SI, Heitzmann D, Fremd C, Klotz MC, Wenz W. Tibialis posterior tendon transfer corrects the foot drop component of cavovarus foot deformity in Charcot-Marie-Tooth disease. J Bone Joint Surg Am 2014; 96:456-62. [PMID: 24647501 DOI: 10.2106/jbjs.l.01749] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The foot drop component of cavovarus foot deformity in patients with Charcot-Marie-Tooth disease is commonly treated by tendon transfer to provide substitute foot dorsiflexion or by tenodesis to prevent the foot from dropping. Our goals were to use three-dimensional foot analysis to evaluate the outcome of tibialis posterior tendon transfer to the dorsum of the foot and to investigate whether the transfer works as an active substitution or as a tenodesis. METHODS We prospectively studied fourteen patients with Charcot-Marie-Tooth disease and cavovarus foot deformity in whom twenty-three feet were treated with tibialis posterior tendon transfer to correct the foot drop component as part of a foot deformity correction procedure. Five patients underwent unilateral treatment and nine underwent bilateral treatment; only one foot was analyzed in each of the latter patients. Standardized clinical examinations and three-dimensional gait analysis with a special foot model (Heidelberg Foot Measurement Method) were performed before and at a mean of 28.8 months after surgery. RESULTS The three-dimensional gait analysis revealed significant increases in tibiotalar and foot-tibia dorsiflexion during the swing phase after surgery. These increases were accompanied by a significant reduction in maximum plantar flexion at the stance-swing transition but without a reduction in active range of motion. Passive ankle dorsiflexion measured in knee flexion and extension increased significantly without any relevant decrease in passive plantar flexion. The AOFAS (American Orthopaedic Foot & Ankle Society) score improved significantly. CONCLUSIONS Tibialis posterior tendon transfer was effective at correcting the foot drop component of cavovarus foot deformity in patients with Charcot-Marie-Tooth disease, with the transfer apparently working as an active substitution. Although passive plantar flexion was not limited after surgery, active plantar flexion at push-off was significantly reduced and it is unknown whether this reduction was the result of a tenodesis effect or calf muscle weakness.
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Affiliation(s)
- T Dreher
- Division for Paediatric Orthopaedics and Foot Surgery, Department for Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany. Email addresses for T. Dreher: ; thomas
| | - S I Wolf
- Division for Paediatric Orthopaedics and Foot Surgery, Department for Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany. Email addresses for T. Dreher: ; thomas
| | - D Heitzmann
- Division for Paediatric Orthopaedics and Foot Surgery, Department for Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany. Email addresses for T. Dreher: ; thomas
| | - C Fremd
- Division for Paediatric Orthopaedics and Foot Surgery, Department for Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany. Email addresses for T. Dreher: ; thomas
| | - M C Klotz
- Division for Paediatric Orthopaedics and Foot Surgery, Department for Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany. Email addresses for T. Dreher: ; thomas
| | - W Wenz
- Foot Surgery and Paediatric Orthopaedics, ATOS Clinic, Heidelberg, Germany
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25
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Karakis I, Gregas M, Darras BT, Kang PB, Jones HR. Clinical correlates of Charcot-Marie-Tooth disease in patients with pes cavus deformities. Muscle Nerve 2013; 47:488-92. [PMID: 23460299 DOI: 10.1002/mus.23622] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2012] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Given its association with Charcot-Marie-Tooth disease (CMT), pes cavus is a common reason for referral to a neurologist. We investigated clinical features that may predict CMT in children with pes cavus. METHODS In this study we retrospectively reviewed pes cavus patients referred to Boston Children's Hospital in the past 20 years. Patients were categorized as idiopathic or CMT, based on EMG/genetic testing, and their clinical features were compared. RESULTS Of the 70 patients studied, 33 had idiopathic pes cavus, and 37 had genetically confirmed CMT. Symptoms of weakness, unsteady gait, family history of pes cavus and CMT, and signs of sensory deficits, distal atrophy and weakness, absent ankle jerks, and gait abnormalities were associated with CMT. CONCLUSIONS In children with pes cavus, certain clinical features can predict CMT and assist in selection of patients for further, potentially uncomfortable (EMG) and expensive (genetic) confirmatory investigations.
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Affiliation(s)
- Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Woodruff Memorial Research Building, 101 Woodruff Circle, Atlanta, Georgia 30322, USA.
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26
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Ball T, Butler M, Parsons S. Pes Cavus - Not just a clinical sign. Diagnosis, Aetiology and Management. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2013. [DOI: 10.47795/wqcw9805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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27
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Iguchi M, Hashiguchi A, Ito E, Toda K, Urano M, Shimizu Y, Takeuchi C, Saito K, Takashima H, Uchiyama S. Charcot-marie-tooth disease type 4C in Japan: Report of a case. Muscle Nerve 2012; 47:283-6. [DOI: 10.1002/mus.23540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2012] [Indexed: 11/07/2022]
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Painful pes planovalgus: an uncommon pediatric orthopedic presentation of Charcot-Marie-Tooth disease. J Pediatr Orthop B 2012; 21:428-33. [PMID: 22744235 DOI: 10.1097/bpb.0b013e3283563750] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Charcot-Marie-Tooth (CMT) disease is an inherited progressive neurologic disorder often diagnosed by the characteristic cavovarus feet. In the pediatric population, the presentation is often more variable and age dependent. Pediatric orthopedic surgeons may be referred patients for the evaluation of musculoskeletal symptoms that may be consistent with early CMT, but because of the lack of the surgeon's familiarity, the diagnosis may be delayed or missed. We present three patients with pes planovalgus who were found to have CMT and review the recent literature relevant to the pediatric orthopedic surgeon. The clinical summary is given for three patients who presented to the orthopedic surgery department for lower extremity symptoms and were eventually diagnosed with CMT. A literature search was performed and information valuable for a pediatric orthopedic surgeon to consider is summarized. Foot morphology in most young children with CMT initially is pes planovalgus, with the minority being pes cavovarus. As the child grows, the proportion changes to become nearly entirely cavus or cavovarus, with very few remaining planovalgus or planus. Unexplained regional pain may also be suggestive of CMT. Whereas CMT often presents initially in adolescent or adult patients with cavovarus feet, thin calves, or a high-stepping gait, pediatric presentation is not so consistent. Young children with CMT often have pes planovalgus. There are even some variants of CMT where patients still may present with severe pes planovalgus into late adolescence. We recommend that pediatric orthopedic surgeons consider CMT even in patients who do not have cavus or cavovarus feet, especially in the context of unexplained regional pain of the lower extremities. Patients should be referred to a pediatric neurologist for definitive diagnosis and management, with the orthopedic surgeon remaining involved for specific procedures.
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Abstract
PURPOSE OF REVIEW To provide the pediatrician with a comprehensive overview of the orthopedic considerations and potential issues in a child with Charcot-Marie-Tooth (CMT) disease. CMT is not one disease but rather a myriad of genetic and biochemical processes that manifest in a final common pathway of physical impairment with cardinal orthopedic elements. RECENT FINDINGS This review incorporates the most current research on CMT, including its orthopedic elements, and the opinion of specialists in pediatric orthopedics specifically in the areas of foot and ankle, hip dysplasia and spinal deformity. SUMMARY This article provides a framework for pediatricians to understand the complex and variable natural history of CMT with regard to neurologically produced musculoskeletal changes.
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30
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Berciano J, Gallardo E, García A, Pelayo-Negro AL, Infante J, Combarros O. New insights into the pathophysiology of pes cavus in Charcot–Marie–Tooth disease type 1A duplication. J Neurol 2011; 258:1594-602. [DOI: 10.1007/s00415-011-6094-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 05/04/2011] [Accepted: 05/04/2011] [Indexed: 11/28/2022]
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31
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Mohamed AR, Rodriguez-Casero MV, Kornberg AJ, Ryan MM. Neurophysiologic findings in children presenting with pes cavus. J Peripher Nerv Syst 2010; 15:238-40. [DOI: 10.1111/j.1529-8027.2010.00272.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Abstract
This article presents a surgical protocol for surgical reconstruction from the subtle cavus foot described by Manoli to the most complicated cases. The goal is to merge together the available surgical options in a comprehensive way to guide surgical decisions.
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Affiliation(s)
- Cristian Ortiz
- Foot and Ankle Surgery, Clinica Alemana, Santiago, Chile.
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33
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Dreher T, Hagmann S, Wenz W. Reconstruction of multiplanar deformity of the hindfoot and midfoot with internal fixation techniques. Foot Ankle Clin 2009; 14:489-531. [PMID: 19712887 DOI: 10.1016/j.fcl.2009.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Reconstruction surgery of the midand hindfoot is a demanding challenge for foot surgeons. Satisfactory results depend not only on surgical technique and skills but also on the knowledge of underlying disorders, pathomechanics, and indication criteria. The cavovarus foot, the planovalgus foot, and Charcot's foot are some of the most challenging foot deformities, requiring different surgical strategies for their correction. Most of the osteotomies and fusions in children and adults can be fixed with transcutaneous Kirschner wires, which are inexpensive and easy to use and remove. The use of alternative fixation systems such as cannulated screws, compression screws, or angle-stable locking plates depends on patient age, vascular situation, risk for nonunion, and underlying pathology.
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Affiliation(s)
- Thomas Dreher
- Division of Pediatric Orthopaedics and Foot Surgery, Orthopaedic Department, University of Heidelberg, Schlierbacher Landstrasse 200a, Heidelberg 69118, Germany
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34
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Johnson BM, Child B, Hix J, Mendicino RW, Catanzariti AR. Cavus foot reconstruction in 3 patients with Charcot-Marie-Tooth disease. J Foot Ankle Surg 2009; 48:116-24. [PMID: 19232961 DOI: 10.1053/j.jfas.2008.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Indexed: 02/03/2023]
Abstract
UNLABELLED Charcot-Marie-Tooth (CMT) is a progressive genetic disorder that produces motor and sensory neuropathy that affects the legs, feet, and hands. A dorsally based closing wedge midfoot osteotomy at the apex of the cavus foot deformity combined with soft tissue and other osseous procedures are procedures performed for CMT patients at The Western Pennsylvania Hospital. The focus of this article is to present a prospective evaluation of 3 patients using radiographic assessment, static biomechanical and the malleolar valgus index (MVI), dynamic alignment, and function results using the F-scan. These results demonstrate that patients have improved function with a plantigrade foot and decreased pain. The Short Form McGill Pain Questionnaire (SF-MPQ) showed that there was a decrease in pain. There was a decrease in the MVI and improved function comparing the preoperative and postoperative F-scan in all patients. The midfoot osteotomy addresses the apex of the progressive cavus foot deformity and provides a plantigrade foot in 3 CMT patients. LEVEL OF CLINICAL EVIDENCE 4.
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Affiliation(s)
- Brandi M Johnson
- Department of Foot and Ankle Surgery, The Western Pennsylvania Hospital, Pittsburgh, USA
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35
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Abstract
Cavovarus foot deformity in children has numerous etiologies with a general pathophysiologic mechanism of muscle imbalance. It is of great importance in the evaluation of a child with a cavovarus foot to determine the underlying cause of the deformity, as the most common origin is a progressive neurologic condition that may be complicated by other orthopedic problems. Treatment options typically are surgical, with limited indications for nonsurgical modalities, and must consider the age of the patient, the nature of the neurologic disease, and the severity of the deformity. Current surgical procedures can be divided into soft tissue procedures to rebalance the muscle forces, osteotomies, and triple arthrodesis. Triple arthrodesis is considered a salvage procedure reserved for the older child with severe, rigid deformity who has failed other surgical treatments.
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Affiliation(s)
- Mark C Lee
- Department of Orthopaedic Surgery, University of Texas at Southwestern Medical Center, TX 75219, USA
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36
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Abstract
Cavovarus foot deformity is a result of a dysbalance of the extrinsic musculature about the foot. Because of the multi-articular bony structure of the foot and ankle, the slightest imbalance of muscular forces causes osteo-articular malalignment and consequent gross deformities. This article discusses hindfoot issues involved in the treatment of cavovarus foot.
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Affiliation(s)
- Kaj Klaue
- Reparto di Chirurgia Ortopedica, Clinica Luganese, sede Moncucco, Via Moncucco 10, CH 6900 Lugano, Switzerland.
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Hornyak JE, Pangilinan PH. Rehabilitation of children and adults who have neuromuscular diseases. Phys Med Rehabil Clin N Am 2007; 18:883-97, vii-viii. [PMID: 17967367 DOI: 10.1016/j.pmr.2007.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neuromuscular diseases are a broad group of disorders that affect the motor unit. Recent advances in genetics and molecular biology have greatly furthered understanding of these diseases. Unfortunately, this has not greatly modified treatment strategies. This article addresses some common features of these diseases, and some less commonly addressed issues.
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Affiliation(s)
- Joseph E Hornyak
- Human Performance Laboratory, Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, USA.
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Affiliation(s)
- Gregory P Guyton
- Union Memorial Hospital, 3333 N. Calvert Street, #400, Baltimore, MD 21218, USA
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