Distance mapping of the foot and ankle joints using weightbearing CT: The cavovarus configuration.

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Abstract

[Indexed for MEDLINE] 17. Instr Course Lect. 2018 Feb 15;67:269-274. Avoiding Failure and Complications in Cavovarus Foot Deformity Reconstruction. Raikin SM(1), Parekh SG. Author information: (1)Director of Foot and Ankle Service and Professor of Orthopaedic Surgery at Thomas Jefferson University, The Rothman Institute, Philadelphia, Pennsylvania. Symptomatic cavovarus foot deformity is frequently associated with neuromuscular conditions, such as Charcot-Marie-Tooth disease, which cause an imbalance between antagonistic muscle groups, thereby leading to the deformity. Avoiding complications in the treatment of patients with cavovarus foot deformity requires a detailed understanding of this imbalance between antagonistic muscle groups and the resulting three-dimensional deformity. Because of the poor outcomes reported in patients with cavovarus foot deformity who undergo nonsurgical treatment or fusion procedures, joint-sparing surgery, including tendon transfers and realignment osteotomies, remain the hallmark of successful management of cavovarus foot deformity. Joint-sparing surgery requires an individualized approach to rebalance the muscles and create a plantigrade functional foot. However, a balanced foot that is achieved via arthrodesis of the hindfoot or midfoot is preferred to undercorrection of a deformity that is managed via joint-sparing surgery. Arthrodesis often is performed in combination with tendon transfers for the salvage of severe deformity and in patients in whom joint-sparing surgery fails, particularly in patients with arthritis. Surgeons should understand the etiology and biomechanics of cavovarus foot deformity and the algorithmic approach for surgical management.