Long-Term Results of Reconstruction for Treatment of a Flexible Cavovarus Foot i

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The Journal of Bone and Joint Surgery (American). 2008;90:2631-2642.

doi:10.2106/JBJS.G.01356

Long-Term Results of Reconstruction for Treatment of a Flexible

Cavovarus Foot in Charcot-Marie-Tooth Disease

M. Ward, MD1, Lori A. Dolan, PhD1, D. Lee , MD1,

A. Morcuende, MD, PhD1 and Reginald R. , MD1

1 Department of Orthopaedic Surgery and Rehabilitation, University of

Iowa, 200 Hawkins Drive, 01023 JPP, Iowa City, IA 52242.

Investigation performed at the Department of Orthopaedic Surgery and

Rehabilitation, University of Iowa, Iowa City, Iowa

Background: Cavovarus foot deformity is common in patients with

Charcot-Marie-Tooth disease. Multiple surgical reconstructive

procedures have been described, but few authors have reported long-

term results. The purpose of this study was to evaluate the long-term

results of an algorithmic approach to reconstruction for the

treatment of a cavovarus foot in these patients.

Methods: We evaluated twenty-five consecutive patients with Charcot-

Marie-Tooth disease and cavovarus foot deformity (forty-one feet) who

had undergone, between 1970 and 1994, a reconstruction consisting of

dorsiflexion osteotomy of the first metatarsal, transfer of the

peroneus longus to the peroneus brevis, plantar fascia release,

transfer of the extensor hallucis longus to the neck of the first

metatarsal, and in selected cases transfer of the tibialis anterior

tendon to the lateral cuneiform. Each patient completed standardized

outcome questionnaires (the Short Form-36 [sF-36] and Foot Function

Index [FFI]). Radiographs were evaluated to assess alignment and

degenerative arthritis, and gait analysis was performed. The mean age

at the time of follow-up was 41.5 years, and the mean duration of

follow-up was 26.1 years.

Results: Correction of the cavus deformity was well maintained,

although most patients had some recurrence of hindfoot varus as seen

on radiographic examination. The patients had a lower mean SF-36

physical component score than age-matched norms, and the women had a

lower mean SF-36 physical component score than the men, although this

difference was not significant. Smokers had lower mean SF-36 scores

and significantly higher mean FFI pain, disability, and activity

limitation subscores (p < 0.0001). Seven patients (eight feet)

underwent a total of eleven subsequent foot or ankle operations, but

no patient required a triple arthrodesis. Moderate-to-severe

osteoarthritis was observed in eleven feet. With the numbers studied,

the age at surgery, age at the time of follow-up, and body mass index

were not noted to have a significant correlation with the SF-36 or

FFI scores.

Conclusions: Use of the described soft-tissue procedures and first

metatarsal osteotomy to correct cavovarus foot deformity results in

lower rates of degenerative changes and reoperations as compared with

those reported at the time of long-term follow-up of patients treated

with triple arthrodesis.