Published online Oct 26, 2019. doi: 10.12998/wjcc.v7.i20.3208
Peer-review started: May 21, 2019
First decision: July 30, 2019
Revised: September 2, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: October 26, 2019
Processing time: 164 Days and 18.9 Hours
Cavovarus foot is a common form of foot deformity in children. It can be simultaneously complicated with forefoot pronation and varus, rearfoot varus, Achilles tendon contracture, or cock-up toe deformity. Many diseases can lead to muscle force imbalance. At present, many surgical treatments are available for cavovarus foot. For older children, priority should be given to midfoot osteotomy and fusion. It is important to preserve the joints and correct the deformity as much as possible.
Currently, diverse treatments are available for cavovarus foot, but there is no standard treatment. Improper treatment will lead to residual deformity or recurrence. Therefore, personalized surgical treatment strategies should be formulated based on preoperative assessment of the deformity and muscle force of the affected foot.
This study aimed to assess the efficacy of soft tissue release combined with joint-sparing osteotomy in the treatment of cavovarus foot deformity in older children.
Clinical data of 21 older children with cavovarus foot deformity were retrospectively analyzed. The patients underwent magnetic resonance imaging of the lumbar spine, electromyographic examination, weight-bearing anteroposterior and lateral X-rays of the feet, and the Coleman block test. Surgical procedures were performed. Therapeutic effects were evaluated. Meary’s angles and Hibbs’ angles were measured based on X-ray images.
Very good results were achieved in 18 feet, good in 7, and fair in 3, with a very good/good rate of 89.3%. At last follow-up, mean Meary’s angle was 6.36° ± 1.810°, and mean Hibbs’ angle was 160.21° ± 4.167°, both of which were significantly improved compared with preoperative values. No complications such as infection, skin necrosis, or bone nonunion occurred.
Soft tissue release combined with joint-sparing osteotomy has appreciated efficacy in the treatment of cavovarus foot deformity in older children, and it can correct the deformity, reduce postoperative recurrence, and preserve the flexibility of the foot as much as possible.
Although satisfactory efficacy can be achieved by soft tissue release combined with joint-sparing osteotomy in children with cavovarus foot deformity, long-tern follow-up data are needed to confirm our conclusion. Future search should utilize big data analysis to formulate accurate treatment plan to minimize complications while guaranteeing the best therapeutic effect.