Clinical and Radiological Assessment of Corrective Osteotomies with or without Arthrodesis in Treatment of Cavovarus Foot Deformity
Authors: Ali Shouman Amro Ashraf ELsayed , Hewaidy Ayman Fathy Ebrahim , Abd-Ella Mohamed Mokhtar , Abdelrahman Amr Farouk 
Published: November 2024

Abstract

Background
Cavovarus foot deformity is a complex deformity. Forefoot pronation and hindfoot inversion are present. There are many causes of cavovarus foot. Some of them are traumatic such as talar malunion or sublaxation of tarsal bones and some of them are neurological such as Charcot-Marie-Tooth (CMT), cerebral palsy or Friedreich ataxia. Patients are mostly presented by pain on lateral side of the foot. Also, they may occasionally suffer from fifth metatarsal stress fracture. Pain along the peroneal tendons and sustaining recurrent ankle sprain due to ankle instability is present. Difficulty in wearing shoes because of the claw toe is also a common complaint. Finally, patients may present with chronic or severe deformity related to severe arthritis of hind foot or ankle joint as well.

Methods
The study included 30 feet in 23 patients with cavovarus foot, who underwent multiple surgical procedures mostly the calcaneal osteotomy and mid foot osteotomy, some patient underwent ankle fusion, triple fusion or first metatarsal osteotomy. Mean Follow-up of patients was 18.4 (12-24) months in both groups with a minimal follow-up of 12 months. In our study which was done on 23 patients with 30 feet, the range of age was from 16 to 51 years old with mean 26.57 ± 10.1. 87% of the patients were males, while 13% were females. We did operations on 19 right feet and 11 left feet. 7 patient underwent bilateral feet operations, not on the same session but at 1 year interval period. Full history and clinical examination was done for all patients, followed by X-rays and CT. All patients were assessed regarding pain, rom, AOFAS, FAAM, FADI score and radiological outcomes. Postoperative complications were recorded. The evaluation was done preoperatively and each time of follow up with a minimum period of 18 months.

Results
In our study which was done on 23 patients with 30 feet, the range of age was from 16 to 51 years old with mean 26.57 ± 10.1. 87% of the patients were males, while 13% were females. We did operations on 19 right feet and 11 left feet. 7 patient underwent bilateral feet operations, not on the same session but at 1 year interval period. FAAM Score had improved with statistically significance in patients from pre with 45.13 ± 8.40 to 55.20 ± 7.80 after one year follow up with P-value &lt;0.001 with mean difference 10.07±3.67. A statistically significant change in FADI Score from pre to post operative in patients after one year follow up from mean 58.90 ± 11.73 to 71.57 ± 11.21 with a mean difference 12.67 ± 4.55. Ankle hind foot scale had improved with statistically significance in patients from pre with 43.33 ± 10.72 to 70.43 ± 9.98 after one year follow up with P-value &lt;0.001 with mean difference 27.1 ± 11.9.

Conclusion
There is a statistically significant improved outcomes functionally and radiologically in surgical treatment of cavovarus feet by midfoot osteotomy, calcaneal osteotomy and tendon achilis lengthening. Level of evidence: Level II.