Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2024; 15(7): 618-626
Published online Jul 18, 2024. doi: 10.5312/wjo.v15.i7.618
Two-stage corrective operation for the treatment of pes cavovarus in patients with spina bifida
Anthony Mack Padgett, Ezan Kothari, Michael J Conklin
Anthony Mack Padgett, Department of Orthopedics, Indiana University, Indianapolis, IN 46202, United States
Anthony Mack Padgett, Ezan Kothari, Michael J Conklin, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, United States
Michael J Conklin, Department of Orthopedic Surgery, Children’s of Alabama, Birmingham, AL 35233, United States
Author contributions: Padgett AM, Kothari E, Conklin MJ designed the study; Kothari E contributed to the data acquisition; Padgett AM and Conklin MJ participated in the analysis and interpretation of data. All authors were actively involved in manuscript drafting, manuscript revision, and critical review of the manuscript for important intellectual content; and all authors approve the manuscript submitted.
Institutional review board statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board.
Informed consent statement: Informed consent was obtained from the parent/legal guardian for the publication of the details of any institutional cases and accompanying images presented in this manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The authors consent to the publication of the data presented in this manuscript. Sharing of other data related to this study may be done upon a reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anthony Mack Padgett, MD, Doctor, Surgeon, Department of Orthopedics, Indiana University, 550 University Blvd #6201, Indianapolis, IN 46202, United States. a.m.padgett2@gmail.com
Received: February 11, 2024
Revised: April 26, 2024
Accepted: June 5, 2024
Published online: July 18, 2024
Processing time: 152 Days and 5.1 Hours
Abstract
BACKGROUND

Pes cavovarus has an estimated incidence of 8%-17% in patients with spina bifida (SB). The majority of the current literature on surgical treatment of cavovarus feet in children and adolescents includes a variety of diagnoses. There are currently no case series describing a treatment algorithm for deformity correction in this specific patient population. The authors of this study present the results of a retrospective case series performed to assess the radiographic outcomes of two-stage corrective surgery in patients with SB.

AIM

To assess the radiographic outcomes of a staged operation consisting of radical plantar release followed by osteotomy for pes cavovarus in patients with SB.

METHODS

Retrospective chart review was performed on patients with SB with a diagnosis of pes cavovarus at a freestanding children’s hospital who underwent surgical correction of the deformity. Patients were excluded for lack of two-stage corrective operation, nonambulatory status, lack of at least six months follow-up, and age > 18 years at the time of surgery. This resulted in a cohort of 19 patients. Radiographic analysis was performed on 11 feet that had a complete series of preoperative and postoperative weightbearing X-rays. Preoperative and postoperative radiographic outcome measurements were compared using a two-sample t-test.

RESULTS

Significant changes between the preoperative and postoperative measurements were seen in Meary’s angle, the anteroposterior talo-first metatarsal (AP TMT1) angle, and the talonavicular coverage. Mean values of Meary’s angle were 17.9 ± 13.1 preoperatively and 4.7 ± 10.3 postoperatively (P = 0.016). Mean AP TMT1 angle was 20.6 ± 15.1 preoperatively and 9.3 ± 5.5 postoperatively (P = 0.011). Mean talonavicular coverage values were -10.3 ± 9.6 preoperatively and -3.8 ± 10.1 postoperatively (P = 0.025).

CONCLUSION

The two-stage corrective procedure demonstrated efficacy in correcting cavovarus deformity in patients with SB. Providers should strongly consider employing the staged surgical algorithm presented in this manuscript for management of these patients.

Keywords: Cavovarus, Spina bifida, Osteotomy, Plantar release, Radiographs, Pediatrics

Core Tip: Currently, there is a paucity of literature on the treatment of pes cavovarus in patients with spina bifida. Cavovarus and cavus are common foot deformities in this patient population. In this article, the authors demonstrate that a two-stage operation consisting of plantar release with subsequent osteotomy demonstrates good correction of the deformity. Outcomes were evaluated by preoperative and postoperative values of six common radiographic measurements.