Treatment of the cavus foot. Deformity in the pediatric patient with Charcot-Marie-Tooth

Abstract

The orthopedic management of foot and ankle problems associated with Charcot-Marie-Tooth disease is becoming better understood but is still evolving. It is now known that Charcot-Marie-Tooth disease should be considered a spectrum of neurologic disorders with variable inheritance patterns, clinical course, and severity of deformities. Over half of the patients with Charcot-Marie-Tooth disease develop foot and ankle problems of which the cavovarus deformity is by far the commonest. Other clinical problems include weakness, parathesias, pain, and an unsteady gait. The cavovarus deformity seems to develop from a relative imbalance between the peroneus longus and tibialis anterior muscles and from an imbalance between the tibialis posterior and peroneus brevis muscles. Treatment of the cavovarus foot deformities should be individualized for each patient after careful preoperative evaluation. Surgery using a variety of soft tissue procedures and osteotomies seems to be the treatment of choice for the progressive cavovarus deformity in younger patients. For a patient who has severely rigid deformities a triple arthrodesis may be the only option but is considered by most to be a salvage procedure. It always should be kept in mind that Charcot-Marie-Tooth disease is a progressive neurologic disorder and the deformities can progress despite surgical intervention. Even though the results of treatment in this disease are difficult to evaluate because of the wide [figure: see text] spectrum of disease, it seems reasonable to believe that early surgical intervention in the flexible cavus foot can restore normal foot posture and help prevent or delay the need for more extensive bony procedures.