Long-term results of reconstruction for treatment of a flexible cavovarus foot in Charcot-Marie-Tooth disease

Abstract

Background: Cavovarus foot deformity is common in patients with Charcot-Marie-Tooth disease. Multiple surgical reconstructive procedures have been described, but few authors have reported long-term results. The purpose of this study was to evaluate the long-term results of an algorithmic approach to reconstruction for the treatment of a cavovarus foot in these patients.

Methods: We evaluated twenty-five consecutive patients with Charcot-Marie-Tooth disease and cavovarus foot deformity (forty-one feet) who had undergone, between 1970 and 1994, a reconstruction consisting of dorsiflexion osteotomy of the first metatarsal, transfer of the peroneus longus to the peroneus brevis, plantar fascia release, transfer of the extensor hallucis longus to the neck of the first metatarsal, and in selected cases transfer of the tibialis anterior tendon to the lateral cuneiform. Each patient completed standardized outcome questionnaires (the Short Form-36 [SF-36] and Foot Function Index [FFI]). Radiographs were evaluated to assess alignment and degenerative arthritis, and gait analysis was performed. The mean age at the time of follow-up was 41.5 years, and the mean duration of follow-up was 26.1 years.

Results: Correction of the cavus deformity was well maintained, although most patients had some recurrence of hindfoot varus as seen on radiographic examination. The patients had a lower mean SF-36 physical component score than age-matched norms, and the women had a lower mean SF-36 physical component score than the men, although this difference was not significant. Smokers had lower mean SF-36 scores and significantly higher mean FFI pain, disability, and activity limitation subscores (p < 0.0001). Seven patients (eight feet) underwent a total of eleven subsequent foot or ankle operations, but no patient required a triple arthrodesis. Moderate-to-severe osteoarthritis was observed in eleven feet. With the numbers studied, the age at surgery, age at the time of follow-up, and body mass index were not noted to have a significant correlation with the SF-36 or FFI scores.

Conclusions: Use of the described soft-tissue procedures and first metatarsal osteotomy to correct cavovarus foot deformity results in lower rates of degenerative changes and reoperations as compared with those reported at the time of long-term follow-up of patients treated with triple arthrodesis.

Fig. 1-A

Figs. 1-A through 1-F Clinical photographs of a male patient with Charcot-Marie-Tooth disease who underwent reconstruction of the left foot at the age of eight years and eight months. In the preoperative photographs (Figs. 1-A, 1-C, and 1-E), the right foot appears to be relatively unaffected by deformity, while the left foot has pronounced hindfoot varus and cavus. The patient was lost to follow-up but returned to the clinic twelve years later, at which time he requested surgery for the right foot. Photographs made at that time (Figs. 1-B, 1-D, and 1-F) show slight recurrence of hindfoot varus and excellent maintenance of the cavus correction of the left (operatively treated) foot and substantial progression of the right (untreated) foot deformity.

Fig. 1-B

Postoperative photograph.

Fig. 1-C

Preoperative photograph.

Fig. 1-D

Postoperative photograph.

Fig. 1-E

Preoperative photograph.

Fig. 1-F

Postoperative photograph.

Fig. 1-G Fig. 1-H

Postoperative radiographs confirm the findings demonstrated by the photographs. The right (untreated) foot has substantial cavus and is shortened compared with the left foot.

Fig. 1-G Fig. 1-H

Postoperative radiographs confirm the findings demonstrated by the photographs. The right (untreated) foot has substantial cavus and is shortened compared with the left foot.