A Wallroth1, T Dreher2. 1. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland. annika.wallroth@med.uni-heidelberg.de. 2. Sektion Kinderorthopädie, Neuroorthopädie und Fußchirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
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.
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.
Authors: Mary K Nagai; Gilbert Chan; James T Guille; S Jay Kumar; Mena Scavina; William G Mackenzie Journal: J Pediatr Orthop Date: 2006 Jul-Aug Impact factor: 2.324
Authors: Nicholas A Beckmann; Sebastian I Wolf; Daniel Heitzmann; Annika Wallroth; Sebastian Müller; Thomas Dreher Journal: J Foot Ankle Res Date: 2015-11-26 Impact factor: 2.303