Modified Chuinard-Baskin Procedure for Managing Mild-to-Moderate Cavus and Claw Foot Deformity in Children and Adolescents

Abstract

Nineteen ambulant patients (children and adolescents, 23 feet), with mild-to-moderate cavus and claw feet of neuromuscular etiology, underwent a modified Chuinard-Baskin operation, combining long toe extensor tendon transfer to the metatarsals with distal tenodesis onto the proximal phalanx. The technique aims to improve forefoot deformity and metatarsophalangeal dysfunction, and to enhance ankle dorsiflexion. Transcutaneous flexor tenotomies in several toes, and additional complementary surgery in the middle and hindfoot (plantar soft tissue releases, tendon lengthenings, and/or transfers and osteotomies/fusions) were also performed, when required. Selection criteria for the target procedure were mild-to-moderate cavus deformity (<45 degrees Meary's angle), restricted ankle dorsiflexion, discomforting symptoms, age span 6 years to maturity, and follow-up had to be at least 2 years. Evaluation was based on modified Frank and Johnson's clinical criteria. Radiologically, the Meary's angle on lateral standing view (long axes of talus/first metatarsal) was used. Global results at last follow-up (mean 6.91 +/- 5.43 years) were excellent in 11 feet (48%), satisfactory in 9 (39%), and unsatisfactory in 3 (13%). This retrospective study showed that satisfactory correction can be obtained in mild-to-moderate claw foot deformity in children and adolescents with this variation of Chuinard-Baskin's operation, and therefore can be used as an alternative to others that are more traditionally used.