SLR - June 2010 - Stanitia Davis
Reference:
Naudi, S. et. al (2009). Anterior tarsectomy long-term results in adult pes cavus. Orthopaedics and Traumatology: Surgery and Research 95, 293-300.
Scientific Literature Reviews
Reviewed by: Stanitia Davis, DPM
Residency Program: Central Alabama Veterans Healthcare Systems
Podiatric relevance:
This article is a review of a surgical procedure and approach to addressing the painful cavus foot deformity. This article is integral within the realm of podiatric medicine with there being a large percentage of podiatric medicine patients with the diagnosis of painful pes cavus. Although many are asymptomatic, there are many who do not have relief with conservative treatment and there are not many options for surgical intervention. This article describes post-operative results of anterior tarsectomy surgery and also yields radiographic and clinical results based on thirty-nine patients with the forefoot deformity.
Methods: This retrospective study involved the Cole-Meary anterior tarsectomy surgical technique between the years 1955 and 2000 on thirty nine-patients with pes cavus deformity in hopes to correct the deformity by resecting a hexahedron shaped area of the anterior tarsus while simultaneously restoring the talometatarsal alignment. Each type of pes cavus deformity was evaluated amongst the population studied. The AOFAS criterion and Kitaoka midfoot scale scores were referenced for clinical results. Stress radiographs were taken post-operatively to assess the Djian and Annonier angles, the Meary's angle, and talar and calcaneal slopes. The Morrey-Wiedman classification was used to evaluate arthritis in adjacent areas near the surgical site.
Results:
After the procedure, five complications were noted peri-operatively: one cuboid fracture, one complete navicular exeresis, two calcaneocuboid staples, and one talonavicular staple. Twelve post-operative complications were noted to involve mal-union and sepsis, amongst the few. There were seven patients who warranted additional surgery for failure of the tarsectomy surgery. One patient developed a callus sub 1st metatarsal head after being without pain for seven years post-operatively. Pain post-operatively primarily involved metatarsalgia. Osteoarthritis was a cause of pain
post-operatively as well, and had an impact on the patients function with activity and walking.
Conclusions:
It is concluded that the etiology impacts the outcome of anterior tarsectomy surgery in patients with painful pes cavus deformity. It was more difficult to see positive results in those patients with neurological etiology than idiopathic etiology of the deformity. Therefore, this procedure is indivcated for "moderate" anterior or mixed pes cavus deformity. Surgery, however, had an effective impact in alleviating pain in 75% of the cases reviewed, especially when evaluating metatarsalgia relief. The procedure's effect on pain alone was poor and over 50% of the patients experienced residual clawfoot deformity. The correction also resulted in other biomechanical factors that impacted the patient in a different way (e.g. hypermobility and osteoarthritis). Therefore, it is imperative that before considering this procedure in addressing pes cavus that all conservative measures are exhausted, and the patient understands that neurological etiology of the deformity has little, positive results in pain alleviation in comparison to idiopathic causes with this surgical procedure.