The Akron Dome Midfoot Osteotomy as a Salvage Procedure for the Treatment of Rig

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J Pediatr Orthop. 2008 January/February;28(1):68-80.

The Akron Dome Midfoot Osteotomy as a Salvage Procedure for the

Treatment of Rigid Pes Cavus: A Retrospective Review.

Weiner DS, Morscher M, Junko JT, y J, Weiner B.

From the *Department of Pediatric Orthopaedic Surgery, Children's

Hospital Medical Center of Akron; †Northeastern Ohio Universities

College of Medicine; ‡Pediatric Orthopaedic Research, Department of

Pediatric Orthopaedic Research, Children's Hospital Medical Center

of Akron; §Summa Orthopaedics and Sports Medicine Center, Summa

Health System, Akron, OH; and & spar;Lakeshore Orthopedics,

Manitowoc, WI; and ¶Division of Spine Surgery, Department of

Orthopaedics, Methodist Hospital/Texas Medical Center, Houston, TX.

OBJECTIVE:: In the early 1970s, the Akron dome osteotomy was

developed as a salvage surgical option to manage rigid cavus

deformity of the foot. This study represents an updated review of

surgical cases between 1972 and 2001 constituting 89 patients

representing 139 feet who were followed at least 2 years after the

index operative procedure. Only cases achieving an unsatisfactory

result followed less than 2 years were included.

STUDY DESIGN:: A retrospective review of cases (all operated by

D.S.W.) was conducted by clinical examination and chart review of

all 89 cases representing 139 feet.

RESULTS:: A satisfactory result was considered pain-free, at least

75% plantigrade foot in contact with the floor without abnormal

symptomatic pressure areas, free of any significant deformity

requiring surgical management. A satisfactory result was obtained in

106 (76%) and unsatisfactory result in 33 feet (24%). When

separating the patients into those younger than 8 years and those

older than 8 years, 67% of the patients younger than 8 years had a

satisfactory result, and 82% older than 8 years had a satisfactory

result. No significant complications were encountered. Because the

surgery is located at the apex of the deformity in frontal, lateral,

and plantar planes at the confluence of the longitudinal and

transverse arches, multiplanar surgical correction was obtained in

all cases at the time of the initial surgery.

Currently, the most common causes of cavus deformity seen in our

series were the sequelae of idiopathic talipes equinus varus

clubfoot, congenital metatarsus varus, and assorted neuromuscular

disorders, including Charcot-Marie-Tooth disease, cerebral palsy,

and arthrogryposis.

CONCLUSIONS:: On the basis of this review, the Akron dome midfoot

osteotomy is a very valuable salvage procedure in the management of

the rigid cavus deformity in children.