Avoiding Failure and Complications in Cavovarus Foot Deformity Reconstruction.
Symptomatic cavovarus foot deformity is frequently associated with neuromuscular conditions, such as Charcot-Marie-Tooth disease, which cause an imbalance between antagonistic muscle groups, thereby leading to the deformity. Avoiding complications in the treatment of patients with cavovarus foot deformity requires a detailed understanding of this imbalance between antagonistic muscle groups and the resulting three-dimensional deformity. Because of the poor outcomes reported in patients with cavovarus foot deformity who undergo nonsurgical treatment or fusion procedures, joint-sparing surgery, including tendon transfers and realignment osteotomies, remain the hallmark of successful management of cavovarus foot deformity. Joint-sparing surgery requires an individualized approach to rebalance the muscles and create a plantigrade functional foot. However, a balanced foot that is achieved via arthrodesis of the hindfoot or midfoot is preferred to undercorrection of a deformity that is managed via joint-sparing surgery. Arthrodesis often is performed in combination with tendon transfers for the salvage of severe deformity and in patients in whom joint-sparing surgery fails, particularly in patients with arthritis. Surgeons should understand the etiology and biomechanics of cavovarus foot deformity and the algorithmic approach for surgical management.
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