The recurring of varus and the lateral shift calcaneal osteotomy in the treatment of cavovarus foot.

Abstract

Objective To discuss the recurring of varus in the treatment of cavovarus foot and the relationship between correcting degree of lateral shift calcaneal osteotomy and the recurring rate.Methods Twenty-three patients (31 feet) with cavovarus foot were treated, which included 9 males and 14 females.According to the Coleman block test before the surgery, the manual passive correcting degree after the medial soft tissue release and/or the tendon lengthening and whether the calcaneal osteotomy were done, and the feet were divided into four groups.There were 0° and beyond 5° two levels of passive valgus for further differentiating and statistically analysis.The calcaneal osteotomy included lateralizing sliding osteotomy, posterior osteotomy and closing wedge osteotomy.Results In the effective following-up of 31 feet, hind foot varus recurred in 9 feet.Five varus were below 5° and 4 varus beyond 5°.The value is 4.23°±2.15°.The varus recurred in 3 feet without calcaneal osteotomy, whose Coleman block test before the surgery could correct the foot to neutral position.The varus did not recur in 4 feet without calcaneal osteotomy whose Coleman block test could correct the foot to more than 5° valgus.If the Coleman block test could not correct varus before the surgery, the varus recurred in 2 feet which could be corrected to neutral position after medial soft tissue release, while only one recurred varus in 3 feet which could be corrected to more than 5 valgus after medial soft tissue release.For the 19 feet with calcaneal osteotomy, one varus recurred in 9 feet which Coleman block test could correct the hind foot into neutral position, two varus recurred in 7 feet which Coleman block test could not correct the varus before the surgery but could correct to neutral position after the medial soft tissue release, no one varus recurred in 3 feet which Coleman block test could not correct the varus before the surgery but could correct to more than 5° valgus after the medial soft tissue release.Conclusion Whether or not the Coleman block test can correct the varus of hind foot, it can not give us the indication of calcaneal lateral sliding osteotomy.Passive manually correcting the hind foot varus is the key of judgement to do the calcaneal osteotomy.Passive valgus 5° is an important guideline. Key words: Clubfoot; Osteotomy; Treatment outcome