Correction Of Foot Deformities Research Articles

Correction of Cavovarus Foot Deformity in Charcot-Marie-Tooth Disease

Operative correction of cavovarus foot deformity in Charcot-Marie-Tooth disease (CMT) is challenging. This progressive peripheral sensory and motor neuropathy commonly involves the forefoot, midfoot, hindfoot, and toes. The authors present a new imaging technique that allows the surgeon to assess the flexibility of the hindfoot in patients with CMT to determine the best operative procedure to correct the deformity. Twenty-five patients (41 feet) with CMT and cavovarus foot deformity were evaluated and a new radiographic technique was studied in some of these patients to determine the usefulness of this imaging modality. The authors believe that this new imaging method will aid in determining the optimal operation for correcting this complex deformity.

Correction of foot deformities by the Ilizarov method without corrective osteotomies or soft tissue release.

Twenty-three foot deformities in 22 patients had been treated without any real surgical incision, 'the bloodless technique', after the application of the Ilizarov external fixator. The ages of the patients ranged from 2 years and 6 months to 49 years. After an average follow-up of 18.3 months (range 8-40 months), all patients had a plantigrade foot. There was no need for soft tissue release or osteotomy. Pin tract infection occurred mostly in the metatarsal wire. However it did not affect final results. The bloodless technique is an effective way of treating foot deformities in children and adults.

Correction of Foot Deformities by the Ilizarov Method without Corrective Osteotomies or Soft Tissue Release

Correction of Foot Deformities by the Ilizarov Method without Corrective Osteotomies or Soft Tissue Release

Lateroposteromedial approach with rhomboid flap method for the treatment of severe club foot deformity

Summary The rhomboid flap method (RFM) is a new technique for primary skin closure utilizing a lateroposteromedial approach to cover skin and soft tissue defects which are the result of full correction of severe club foot deformity. The vertical incision of the lateroposteromedial approach declines laterally at approximately 30 degrees from midline which widens the rhomboid flap, thus preserving blood supply to the flap and preventing scar adhesions to the Achilles tendon. After full correction, the wound is covered by the stretched rhomboid flap. The RFM was used in 51 patients aged between 6 months and 8.5 years at the Al-Razi Orthopaedic Hospital, Kuwait. The follow-up was between 23 and 60 months. The RFM was used in 62 cases: 59 primary surgeries and three revisions of previous surgeries. Sufficient skin cover was achieved in all cases. In 59, healing was by primary intention and, in three, necroses smaller than 1 cm 2 developed. The RFM proved to be a beneficial method in the treatment of severe clubfoot in the age group concerned.

Triple arthrodesis: internal fixation with staples

Triple arthrodesis of the hindfoot as a salvage procedure for hindfoot problems is a well-known procedure first described in 1921 by Hoke. Since then a variety of operative techniques have been described. Throughout the years the indications for triple arthrodesis has expand ed. Today they are: pain relief; correction of non-acceptable foot deformities; and correction of instabilities. We reviewed the results of 31 triple arthrodesis in 29 patients with an average follow-up of 5 years. We used a technique with one incision and staple fixation. The patients were allowed weight bearing in a short leg cast immediately after the operation. The patients had a variety of disorders but in all cases we performed the operation as a salvage procedure for invalidating hindfoot pain, instability and/or deformity. The results were satisfactory overall, even though some of the patients were not completely free of pain and some had no improvement in function.

Correction of foot deformities with the Ilizarov method

Correction of foot deformities with the Ilizarov method

I.v. regional diamorphine for analgesia after foot surgery

Opioids administered to peripheral tissues can have significant analgesic effects in doses which would not be effective centrally. We have assessed the effects of regional diamorphine 2.5 mg i.v. in 14 patients undergoing surgical correction of bilateral arthritic foot deformities in a prospective, randomized, double-blind study. Patients acted as their own controls as only one foot received the active drug. Visual analogue scale (VAS) pain scores and wound tenderness were measured over 72 h. Diamorphine did not improve median VAS area under the curve pain scores during the first 6 h after surgery (33 (95% confidence intervals (CI) 25-46) vs 24 (17-35)). It also did not effect wound hypersensitivity when tested at 72 h after surgery (95 (47-125) vs 90 (50-125) g). There were no significant adverse effects.

Indication of the Ilizarov method for the correction of foot deformity

Indication of the Ilizarov method for the correction of foot deformity

Subtalar Staple Arthroereisis for Planovalgus Foot Deformity in Children with Neuromuscular Disease

Twenty-two patients (34 feet) with severe, flexible, planovalgus feet due to neuromuscular conditions were treated with subtalar staple arthroereisis. Patients were followed up for an average of 5 years (range, 2.5-9 years). Of the 34 feet, 18 did not require revision surgery; however, the remaining 16 feet required revision at an average of 39 months after surgery (range, 9-63 months). Revision procedures consisted of hardware removal in four cases, repeated subtalar stapling in one, triple arthrodesis in two, and calcaneal with or without cuboid and cuneiform osteotomy in nine feet. The long-term results of subtalar staple arthroereisis were unpredictable, and although it was effective in approximately half of our patients, we no longer recommend this procedure for the correction of the neuromuscular planovalgus foot deformity.

Calcaneal-cuboid-cuneiform osteotomy for the correction of valgus foot deformities in children.

We performed combination calcaneal-cuboid-cuneiform osteotomies in 18 patients (26 feet) with severe valgus foot deformity. The operation consists of a sliding calcaneal osteotomy, an opening-wedge cuboid osteotomy, and a pronation, plantar flexion closing-wedge osteotomy of the medial cuneiform in addition to appropriate soft-tissue releases. The preoperative goals of restoring the axis of the foot parallel to the axis of progression and relieving pain, as well as shoe, brace, and skin problems, were met in 23 of the 24 feet available for review at an average of 18 months after surgery. This procedure has the advantage of localized correction of deformity without the problems associated with arthrodesis.

Partial Wound Closure Following Surgical Correction of Equinovarus Foot Deformity

Partial Wound Closure Following Surgical Correction of Equinovarus Foot Deformity

Partial wound closure after surgical correction of equinovarus foot deformity.

Full correction of severe equinovarus foot deformities is frequently lost at the end of surgical release when the surgeon closes the skin incision. We retrospectively review 31 feet in 22 patients whose medial skin incisions were left open (typically 10 mm) to heal by secondary intention. The criterion to leave a wound open was if primary closure with the foot in full correction might compromise circulation to the skin or if closing the incision would require loss of corrected position. One or two cast changes were performed under outpatient anesthesia at 7- to 14-day intervals for wound care. All wounds except one were healed by week 6 at time of outpatient clinic cast removal. The appearance of the incisions is similar to feet in which primary closure is possible. One foot required split-thickness skin grafting at 3 weeks postoperatively to achieve wound coverage. There were no infections. We conclude that primary skin closure is not essential after surgical correction of equinovarus foot deformity, and that correction need not be compromised to approximate skin.

Partial Wound Closure After Surgical Correction of Equinovarus Foot Deformity

Summary: Full correction of severe equinovarus foot deformities is frequently lost at the end of surgical release when the surgeon closes the skin incision. We retrospectively review 31 feet in 22 patients whose medial skin incisions were left open (typically 10 mm) to heal by secondary intention. The criterion to leave a wound open was if primary closure with the foot in full correction might compromise circulation to the skin or if closing the incision would require loss of corrected position. One or two cast changes were performed under outpatient anesthesia at 7- to 14-day intervals for wound care. All wounds except one were healed by week 6 at time of outpatient clinic cast removal. The appearance of the incisions is similar to feet in which primary closure is possible. One foot required splitthickness skin grafting at 3 weeks postoperatively to achieve wound coverage. There were no infections. We conclude that primary skin closure is not essential after surgical correction of equinovarus foot deformity, and that correction need not be compromised to approximate skin.

Residual Bone Cysts After Correction of Severe Foot Deformities with the Ilizarov Technique

Fourteen patients with severe foot deformity treated by application of the Ilizarov device were evaluated for residual bone changes in the foot. Cyst formation was noted in all patients, most commonly in the base of the fifth metatarsal. These cysts did not develop in the area of bone penetrated by the wires. In an average follow-up of 3.4 years after device removal, the cysts did not resolve. Histologic examination of one resected cyst demonstrated an empty lacuna with no cell lining, as seen in the "cysts" associated with osteoarthrosis.

Surgical correction of talipes equinovarus following foot and leg compartment syndrome.

Between 1984 and 1994, 40 patients with a posttraumatic compartment syndrome of the lower leg and foot were treated for talipes equinovarus adductus foot deformity, which subsequently developed. Twenty patients had a wedge osteotomy followed by arthrodesis of the midtarsal joint (Chopart joint). Another 17 patients had an arthrodesis of the midtarasal and subtalar joints. In the remaining three patients, in addition to arthrodesis, lengthening of the tendons of the long flexors and the Achilles tendon was performed. Complications included wound infections (six cases), drill hole infections (three cases), chronic osteomyelitis (one case), and an ankle joint infection (one case). The clinical result was assessed as good in 37.5%, fair in 52.5%, and poor in 10% of the patients. Before the operation, 37 patients required modified footwear. After the operation, only eight patients needed them. Wedge osteotomy of the midtarsal and subtalar joints followed by an arthrodesis is an advantageous treatment modality for the correction of severe postischemic equinovarus adductus foot deformities. In our study, patient satisfaction was high. While complications frequently occur, it is not extraordinary considering the salvage nature of the procedure.

Transposed skin graft for wound closure after Cincinnati incision. Experience in 7 patients with severe foot deformities.

I report a technique of wound closure by a transposed skin graft after operative treatment of foot deformities, using a Cincinnati incision. Three-dimensional correction of severe foot deformities (congenital talipes equinovarus, congenital vertical talus, etc.) results in skin excess on one side of the foot and lack of this on the opposite side. The skin excess can be cut out and used as a full-thickness skin graft for wound closure on the opposite side of the foot.

Correction of Foot Deformity by the Ilizarov Method in a Patient With Segawa Disease

Hereditary progressive dystonia, or Segawa disease, is rare. Diagnosis depends on typical clinical features with normal laboratory findings. It responds well to levodopa treatment. This article contains a case report of a patient with Segawa disease with a fixed equinovarus foot. A 21-year-old woman was diagnosed with Segawa disease since she was 8 years old; she became wheelchair dependent at the age of 15. The dystonia responded well to levodopa, except for the fixed-foot deformity. The deformity was corrected successfully by the Ilizarov method. The patient returned to independent ambulation after surgery. Because similar types of foot deformities appeared in several progressive degenerative neurologic diseases, the treatable Segawa disease should be added to the list of differential diagnoses of progressive degenerative neurological diseases with talipes equinovarus.

The surgical treatment of the equinovarus deformity in patients with Duchenne's muscular dystrophy

We report about the surgical correction of foot deformities in Duchenne patients that have lost their ability to walk and stand. To enable the patient to stand in a supportive device a graduated surgical regime of treatment was introduced, oriented to the degree of foot deformation. The patient must be mobilized after surgery quickly in order to avoid further strength loss. Because of this only soft tissue surgery on Duchenne patients is performed in our clinic. To prevent the recurrence of the deformities, orthoses are mandatory.

Elective Foot Surgery in Limbs With Arterial Disease

Surgical correction of foot deformities is generally indicated to relieve the disability. The presence or suspicion of arterial disease may lead to the reluctance to operate because of the concern that healing might not occur, however. Twenty-three patients were referred for vascular assessment before elective foot surgery. There was little or no evidence of arterial disease in 15 limbs. In eight limbs there was unequivocal evidence of complete obstruction in the main limb artery. Contrary to what might be expected, healing after surgery occurred without difficulties in the limbs with arterial obstruction. The arterial disease as assessed by laboratory methods was not severe. The results indicate that elective foot surgery can be safely undertaken in some limbs. Simple laboratory methods for assessment of arterial circulation include measurements of distal blood pressure, skin temperature, transcutaneous oxygen tension, and assessment of digital pulsatility. A useful approach for estimating the chances of healing after elective surgery in limbs with arterial obstruction is formulated on the basis of the clinical and laboratory assessment.

Modified Cole Derotational Wedge Midfoot Osteotomy for the Equinocavovarus Foot

Summary: A previously unreported modification to the Cole mid-foot osteotomy is described for correction of rigid equinocavovarus foot deformities. Axial derotation or pronation of the forefoot prior to the second cut of a wedge osteotomy of the anterior tarsus allows for correction of cavus, varus, and associated supination deformity of the foot without creating a lateral rocker, prominent fifth metatarsal base, excessive shortening, or violation of hindfoot articulations. Pronation of the forefoot may exacerbate an existing plantar-flexed first metatarsal bone, which can be corrected by dorsiflexion osteotomy of the first ray, resulting in a mobile plantigrade foot.