Surgical treatment of advanced, stiff neurologic cavovarus foot in adults.

BACKGROUND Cavovarus foot is a complex, three-dimensional deformity of neuromuscular origin. A rigid cavovarus deformity causes difficulty in walking, instability, fatigue fractures, calluses and trophic ulcers in the overloaded lateral part of the foot and requires wearing orthopaedic shoes. The aim of the study was to evaluate current surgical techniques in the treatment of rigid cavovarus foot in adults. MATERIAL AND METHODS This paper is a retrospective analysis of 14 patients (15 feet) treated surgically at our centre who presented with advanced cavovarus foot caused by a spectrum of neuromuscular diseases such as Charcot-Marie-Tooth, poliomyelitis, cerebral palsy, myelomeningocele, diabetes (Charcot's neuroarthropathy), sequelae of strokes and CNS injuries, compartment syndrome and inveterate sciatic nerve injuries. Average patient age was 53 years. Average follow-up period was 24 months (range: 18-58). The AOFAS scoring system was used to assess treatment results. RESULTS The mean AOFAS score before surgery was 24 (range: 8-35) points and increased to 60 (range: 40-76) points after surgery. A stable, plantigrade, painless foot was achieved in all treated patients. CONCLUSIONS 1. Surgical treatment of advanced cavocarus foot of neuromuscular origin should be carried out in a staged process with reassessment and adaptation of subsequent stages rather than following a rigid scheme. 2. The surgeon must be familiar with a number of techniques and procedures in order to correct the bony deformity and achieve muscle imbalance correction in a single-stage surgery.