Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 9 , ISSUE 4 ( October-December, 2022 ) > List of Articles


Correction of Talipes Cavovarus with Simultaneous Foot Lengthening in a Spina Bifida Patient

Rajyalakshmi N Reddy, Somasekhara R Nallamilli, Venkataramana R Neelam

Keywords : Avoiding toe contractures while correcting foot deformity and foot lengthening, Correction of cavovarus foot deformity in spina bifida with an external fixator, cosmetic foot lengthening, distraction osteogenesis foot lengthening by osteotomy of the bases of all metatarsal bones, extra-articular valgus osteotomy of calcaneum to correct heel varus, joint preservation during foot deformity correction and foot lengthening, medial column lengthening of cavovarus foot with an external fixator, ring fixator vs. uniplanar fixator for foot deformity correction

Citation Information : Reddy RN, Nallamilli SR, Neelam VR. Correction of Talipes Cavovarus with Simultaneous Foot Lengthening in a Spina Bifida Patient. J Foot Ankle Surg Asia-Pacific 2022; 9 (4):192-195.

DOI: 10.5005/jp-journals-10040-1221

License: CC BY-NC 4.0

Published Online: 07-10-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Spina bifida can leave a permanent foot deformity into adulthood with a difficulty in walking and with a risk of callosities and pressure sores. Arthrodesis surgeries lead to stiff joints with an associated high risk of skin breakdowns. Hence, it is important that any corrective surgery must spare the joints. Extra-articular bony osteotomies and tenotomies are preferred, especially in cases with sensory deficits. Both joint fusions and closed wedge osteotomies share the disadvantage of shortening the foot. This is more relevant in cases where the affected foot is already short; hence, saving the length of the foot is a priority. Case description: A 14-year-old girl presented with a cavovarus foot on the right side, which is short by about 3 cm compared to that on the left side. After soft tissue releases, basal osteotomies of all the metatarsal bones were done, and the medial column was lengthened by distraction osteogenesis. This procedure corrected the forefoot deformity and also helped in increasing the length of the foot by 8 mm. Heel varus needed an Extra-articular osteotomy of calcaneum in a separate procedure. In a follow-up, 6 years after the operation, the patient's foot remained plantigrade though with a mild residual deformity, but the patient is walking well wearing normal shoes. Conclusion: This technique to correct deformity with simultaneous lengthening of the foot is not described before and is suited well for this patient. Surgical treatment of mature deformed feet with special problems needs to be individualized, and in cases like this, we found that our technique is safe and can be considered in similar situations.

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  1. Akbar M, Bresch B, Seyler TM, et al. Management of orthopaedic sequelae of congenital spinal disorders. J Bone Joint Surg Am 2009;91(Suppl 6):87–100. DOI: 10.2106/JBJS.I.00613
  2. Flynn JM, Herrera-Soto JA, Ramirez NF, et al. Clubfoot release in myelodysplasia. J Pediatr Orthop B 2004;13(4):259–262. DOI: 10.1097/01.bpb.0000124491.13918.b7
  3. Westcott MA, Dynes MC, Remer EM, et al. Congenital and acquired orthopedic abnormalities in patients with myelomeningocele. Radiographics 1992;12(6):1155–1173. DOI: 10.1148/radiographics.12.6.1439018
  4. Swaroop VT, Dias LS. Orthopaedic management of spina bifida—part II: foot and ankle deformities. J Child Orthop 2011;5(6):403–414. Published online 2011. DOI: 10.1007/s11832-011-0368-9
  5. Ponseti IV, Smoley EN. The classic: congenital clubfoot: the results of treatment. Clin Orthop Relat Res 2009;467(5):1133–1145. Published online 2009. DOI: 10.1007/s11999-009-0720-2
  6. Maynard MJ, Weiner LS, Burke SW. Neuropathic foot ulceration in patients with myelodysplasia. J Pediatr Orthop 1992;12(6):786–788. DOI: 10.1097/01241398-199211000-00016
  7. Sharrard WJ, Grosfield I. The management of deformity and paralysis of the foot in myelomeningocele. J Bone Joint Surg Br 1968;50(3):456–465.
  8. Frawley PA, Broughton NS, Menelaus MB. Incidence and type of hindfoot deformities in patients with low-level spina bifida. J Pediatr Orthop 1998;18(3):312–313. DOI: 10.1097/01241398-199805000-00007
  9. Lourenco AF, Dias LS, Zoellick DM, et al. Treatment of residual adduction deformity in clubfoot: the double osteotomy. J Pediatr Orthop 2001;21(6):713–718.
  10. Schwend RM, Drennan JC. Cavus foot deformity in children. J Am Acad Orthop Surg 2003;11(3):201–211 DOI: 10.5435/00124635-200305000-00007
  11. Mubarak SJ, Van Valin SE. Osteotomies of the foot for cavus deformities in children. J Pediatr Orthop 2009;29(3):294–299. DOI: 10.1097/BPO.0b013e31819aad20
  12. Kitabata R, Sakamoto Y, Nagasao T, et al. Distraction osteogenesis for brachymetatarsia by using internal device. Plast Reconstr Surg Glob Open 2017;5(7):e1381. DOI: 10.1097/GOX.0000000000001381
  13. Mosca VS. Calcaneal lengthening for valgus deformity of the hindfoot. Results in children who had severe, symptomatic flatfoot and skewfoot. J Bone Joint Surg 1995;77(4):500–512. DOI: 10.2106/00004623-199504000-00002
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