Corrective procedures and indications for cavovarus foot deformities in children and adolescents

Abstract

Cavovarus deformities in children and adolescents require sound considerations concerning the timing for corrective surgery. Progression can be recognized best by repeated pedographic examination with evaluation of the typical features of cavovarus deformity. Surgical correction consists of acombination of soft tissue release, bony realignment, and restoration of muscle balance. In most cases plantar or medioplantar soft tissue release should be considered, whereas calf muscle lengthening is rarely indicated. Typical joint-sparing bone procedures are elevating osteotomies at the medial tarsometatarsal ray and realigning calcaneal osteotomies. Advanced cases require navicular-cuneiforme arthrodesis for correction of severe cavus component, hindfoot fusion at the Chopart line, or Lambrinudi triple fusion. Supramalleolar rotational osteotomy should be considered in severe cases. Peroneal dysfunction is addressed by peroneus longus to brevis transfer, posterior tibial tendon transfer compensates for severe extensor weakness to acertain degree, claw toes can be rebalanced by flexor or extensor tendon transfer, often in combination with proximal interphalangeal joint fusion. Surgical treatment should take into account the components of deformity, muscular function, progression and the underlying disease of the individual case. Further deterioration can be prevented by adequate surgery in the young patient. However, repeated surgical interventions may be necessary later in this patient group.