CMT children's cavovaris feet: role of the dynamic pedobarograph in assessing tr

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J Pediatr Orthop. 2007 Jul-Aug;27(5):510-6.

The role of the dynamic pedobarograph in assessing treatment of

cavovarus feet in children with charcot-marie-tooth disease.

Chan G, Sampath J, F, Riddle EC, Nagai MK, Kumar SJ.

From the Department of Orthopedics, Alfred I. duPont Hospital for

Children, Wilmington, DE.

We used the dynamic pedobarographs to study pressure distribution

patterns in the foot after surgical correction of cavovarus feet. We

also assessed the influence of ankle power generation on pressure

distribution in these feet.

Nine children (14 feet) diagnosed with Charcot-Marie-Tooth disease

who had undergone operative treatment with a combination of

osteotomies and muscle transfers were the subjects of this study.

Preoperative and postoperative pedobarographic measurements recorded

included pressure over the medial forefoot, lateral forefoot, medial

midfoot (MMF), lateral midfoot (LMF), and heel segments. In 6

patients (9 feet) who had a complete gait analysis, the power

generation of the ankle was also obtained both preoperatively and

postoperatively. Lateral radiographic measurements included the (1)

talus-first metatarsal angle, (2) calcaneus-first metatarsal angle,

and (3) calcaneal pitch.

The radiographs showed significant improvements in all 3 angles.

Increased LMF and decreased forefoot pressures were seen on

preoperative pedobarographic measures.

Postoperatively, improvement in pressure at the LMF was seen. When

postoperative measurements were compared with the normal values,

only the LMF was similar; the other 4 segments showed decreased

forefoot and MMF pressures and increased heel pressures (P = 0.000

for the lateral forefoot and MMF; 0.040 for the heel and medial

forefoot). The heel pressures displayed an inverse relationship to

ankle power generation.The amount of correction achieved

radiographically did not correlate with pedobarographic

measurements. The increased heel pressure that was noted was not

addressed by treatment.

Normalization of pressure patterns should be the goal in treating

children with symptomatic cavovarus feet. Although the foot

deformity is corrected completely in neuromuscular disorders,

pressure distribution was not normalized, and therefore, symptoms

might persist. Both patients and parents should be informed about

this possible problem before surgical intervention.