Department of Orthopaedics, Foot and Ankle Reconstruction Unit, Sint Maartenskliniek, Nijmegen, The Netherlands.
Foot Ankle Surg. 2010 Sep;16(3):142-7. doi: 10.1016/j.fas.2009.10.002.
The purpose of this paper was to retrospectively evaluate the short-term to mid-term results of combined first ray proximal dorsiflexion osteotomy and soft tissue surgery in treatment of pes cavovarus with a fixed plantar flexed first ray and a passively correctable tarsus due to Charcot-Marie-Tooth disease.
Between January 1995 and July 2005, thirty-three patients with pes cavovarus deformity due to Charcot-Marie-Tooth disease were included. All patients had in common that prior to surgery the hindfoot was passively still adequate correctable at the talonavicular joint. The Coleman block test was performed to establish with certainty that hindfoot varus was a secondary deformity. Fourteen patients were male (21 feet) and nineteen were female (31 feet). Mean age at surgery was 28.1 years (range 13-59 years). Mean follow-up time was 56.9 months (range 13-153 months). Evaluation consisted of physical examination of all patients with assessment of early and late complications. The validated Foot Function Index (FFI) was used to measure pain and impairment. Patients' satisfaction was assessed by a Quality of Care Through the Patients' Eyes (QUOTE) questionnaire.
Surgical correction of cavovarus foot deformity consisted of dorsiflexion osteotomy at the base of the first metatarsal combined with tendon transfers. Secondary calcaneal osteotomy was performed in case of persistent varus of the calcaneus.
No major complications were seen. Recurrence of cavovarus deformity in two feet resulted in triple arthrodesis 37 and 64 months postoperatively. The FFI 5-point score for pain improved from a mean 29.3% to a mean 14.8% (p=0.005). The score for disability improved from a mean 37.8% to a mean 23.5% (p<0.001). Patients' satisfaction was assessed by the QUOTE questionnaire. Seventy percent of the patients could walk barefoot after the operation and 77% of the patients had less pain after surgery. Pressure callosities diminished in 81%. Foot function was considered better after surgery by 84%. Ninety percent was satisfied with the correction of the deformity.
First ray dorsiflexion osteotomy combined with tendon transfers is a good and consistent solution to realign the foot and provides short-term to mid-term satisfactory results in 90% of patients with a rigid forefoot cavus deformity due to plantar flexion of the first ray and with a still passively reducible tarsus.
本文旨在回顾分析联合第一跖骨近端背屈截骨术和软组织手术治疗因 Charcot-Marie-Tooth 病导致的刚性前足内翻畸形伴第一跖骨被动可矫正的固定跖屈和可被动矫正的跗骨的中短期结果。
1995 年 1 月至 2005 年 7 月，共纳入 33 例因 Charcot-Marie-Tooth 病导致的足内翻畸形患者。所有患者的共同点是，在手术前，距下关节的后足仍可被动充分矫正。进行 Coleman 块试验以确定后足内翻是否为继发畸形。14 例为男性（21 足），19 例为女性（31 足）。手术时的平均年龄为 28.1 岁（范围 13-59 岁）。平均随访时间为 56.9 个月（范围 13-153 个月）。对所有患者进行体格检查并评估早期和晚期并发症，以进行评估。使用经过验证的足部功能指数（FFI）来测量疼痛和功能障碍。通过患者满意度调查问卷（Quality of Care Through the Patients' Eyes，QUOTE）评估患者满意度。
足内翻畸形的手术矫正包括第一跖骨基部的背屈截骨术，结合肌腱转位。如果跟骨仍存在内翻，可进行跟骨二次截骨术。
无重大并发症。2 例患者出现足内翻畸形复发，分别于术后 37 个月和 64 个月行三关节融合术。FFI 疼痛 5 分评分从平均 29.3%改善至平均 14.8%（p=0.005）。残疾评分从平均 37.8%改善至平均 23.5%（p<0.001）。患者满意度通过 QUOTE 问卷评估。术后 70%的患者可赤脚行走，77%的患者术后疼痛减轻。81%的胼胝压力减轻。84%的患者认为术后足部功能改善。90%的患者对畸形矫正满意。
第一跖骨背屈截骨术结合肌腱转位是一种治疗刚性前足内翻畸形的良好且一致的方法，可使 90%的因第一跖骨跖屈和仍可被动矫正的跗骨导致的刚性前足内翻畸形患者获得短期至中期满意的结果。
