SLR - August 2009 - Rachel Johnson
Reference:
Wülker, N., Hurschler, C. (2002). Cavus foot correction in adults by dorsal closing wedge osteotomy. Foot & Ankle International, 23(4), 344-347.
Scientific Literature Reviews
Reviewed by: Rachel Johnson, DPM
Residency Program: OCPM-UHHS Richmond Medical Center
Podiatric Relevance:
This retrospective study discusses 1 potential surgical intervention for the treatment of adult cavus foot deformity with the dorsal closing wedge osteotomy. The study
provides follow-up of the procedure ranging from 24 to 80 months.
Methods:
Twelve patients (thirteen feet) underwent dorsal closing wedge osteotomy for the treatment of cavus foot. The distribution divided evenly with six males and six females ranging in age from 22 to 57 years, with a mean age of 40.1 years. One patient was excluded due to inability to attend follow-up appointments at the time of study. The osteotomy was performed on deformities with normal calcaneal pitch, abnormal Meary’s angle on weightbearing lateral radiograph, and apex of deformity at tarsal level between Chopart’s and Lisfranc’s joint. All patients had previously been treated with inserts or shoe modifications with no relief. Chief complaints consisted of plantar pain on weightbearing. A dorsal closing wedge was directed between Lisfranc’s and Chopart’s joint with the size of wedge based on Meary’s angle on preoperative radiographs. Various methods of internal fixation were used. Evaluation retrospectively consisted of patient self evaluation, physical examination, weightbearing lateral and AP radiographs, and plantar pressure distribution with an ink mat.
Results:
Eleven patients were evaluated (12 feet). Eight patients (9 feet) were satisfied with the procedure. Three patients (3 feet) were not satisfied. The reason for dissatisfaction was moderate pain on weightbearing. Four patients had revisional/additional surgery. One of the revisions was due to nonunion. One patient had an Achilles tendon lengthening. Two patients had extensor digitiorum longus tendon transfer to the metatarsals and IPJ fusion of the hallux. Two patients were completely pain free at follow up. Six patients complained of mild, occasional pain. Two patients had moderate pain. Pain was restricted to midfoot and not plantarly. Weightbearing radiographs postoperatively revealed an average Meary’s angle of 14 degrees. The average correction from the osteotomy was 23 degrees. Plantar weightbearing pattern showed 3 patients had normal patterns, slightly abnormal in 5 patients, and markedly abnormal in 3 patients.
Conclusions:
No recurrence of deformity was noted. Approximately, one third of patients in the study were not completely satisfied with their outcomes. Most patients had improvement from preoperative condition, but still had mild to moderate pain. This study provides evidence that if the cavus foot deformity has an apex at the tarsus, a dorsal closing wedge osteotomy may be an appropriate procedure for surgical correction.