Yang Jie,Yang Zheng,Yan Guisen,et al.Treatment of pediatric cavovarus foot with balance anterior transfer of tibialis posterior and peroneus brevis[J].Journal of Clinical Pediatric Surgery,,21():248-252.[doi:10.3760/cma.j.cn101785-202108036-009]
Treatment of pediatric cavovarus foot with balance anterior transfer of tibialis posterior and peroneus brevis
- Keywords:
- Talipes/SU; Orthopedic Procedures/MT; Treatment Outcome; Child
- Abstract:
- Objective To explore the application of balance anterior transfer of tibialis posterior muscle and fibula brevis muscle in the treatment of pediatric cavovarus foot and summarize its operative approaches, technical advantages and long-term outcomes.Methods Twenty-one children with 25 feet of cavovarus foot were treated.The operative age was (11.10±2.08) years and the average follow-up period (4.37±1.14) years.Through surgical soft tissue release, osteotomy (cuboid, medial cuneiform or midtarsal joint osteotomy, etc.) was employed for correcting foot deformity.Transfer advancement of tibialis posterior muscle and peroneus brevis muscle was performed for balancing the strength of foot; Kirschner wire was utilized for fixing osteotomy and cast applied for 6 weeks post-operation.At Year 1 post-operation, therapeutic effect was consolidated by wearing a walking brace and manual massage.During follow-ups, radiological films of weight-bearing foot were taken and angles measured.Foot and ankle functions were evaluated by the scores of American Orthopedic Foot and Ankle Association (AOFAS) Ankle-Posterior Foot and Foot and Ankle Ability Measure (FAAM).Results Through comparing radiological manifestations, appearance and functional status of feet before, after and during follow-ups, all of them resumed walking with weight-bearing.One case of recurrent malformation was re-operated.Another case of skin deficit healed after dressing change.No significant difference existed in Kite angle before, after and at the last follow-up (>3 years post-operation) (F=1.973, P=0.162).The differences of Hibbs angle before, after and at the last follow-up (>3 years post-operation) were statistically significant (F=63.831, P<0.001).By pair comparison, mean values before and after operation and at the last follow-up (>3 years post-operation) were statistically different from each other while mean values post-operation and at the last follow-up (>3 years post-operation) were statistically different from each other.Statistically significant differences existed in Meary angle and calcaneus angle pre-operation, post-operation and at the last follow-up (>3 years post-operation) (P<0.001).There was a declining trend of Meary angle over time.For AOFAS and FAAM scores, the differences were statistically significant (P<0.05). Conclusion For children with cavovarus foot, balance anterior transfer of tibialis posterior and peroneus brevis may achieve an excellent balance of internal and lateral dorsoflexion strength.It maintains the postoperative efficacy of foot deformity correction.
References:
[1] 伍江雁, 梅海波, 刘昆, 等.Japas手术治疗儿童特发性高弓足的疗效观察[J].临床小儿外科杂志, 2008, 7(2):11-14.DOI:10.3969/j.issn.1671-6353.2008.02.005.Wu JY, Mei HB, Liu K, et al.Clinical efficacy for idiopathic pes cavus in children with Japas operation[J].J Clin Ped Sur, 2008, 7(2):11-14.DOI:10.3969/j.issn.1671-6353.2008.02.005.
[2] Sanpera I Jr, Frontera-Juan G, Sanpera-Iglesias J, et al.Innovative treatment for pes cavovarus:a pilot study of 13 children[J].Acta Orthop, 2018, 89(6):668-673.DOI:10.1080/17453674.2018.1486525.
[3] Younger AS, Hansen ST Jr.Adult cavovarus foot[J].J Am Acad Orthop Surg, 2005, 13(5):302-315.DOI:10.5435/00124635-200509000-00004.
[4] Erickson S, Hosseinzadeh P, Iwinski HJ, et al.Dynamic pedobarography and radiographic evaluation of surgically treated cavovarus foot deformity in children with Charcot-Marie-Tooth disease[J].J Pediatr Orthop B, 2015, 24(4):336-340.DOI:10.1097/BPB.0000000000000163.
[5] Wicart P, Seringe R.Plantar opening-wedge osteotomy of cuneiform bones combined with selective plantar release and dwyer osteotomy for pes cavovarus in children[J].J Pediatr Orthop, 2006, 26(1):100-108.DOI:10.1097/01.bpo.0000189005.78045.17.
[6] d’Astorg H, Rampal V, Seringe R, et al.Is non-operative management of childhood neurologic cavovarus foot effective?[J].Orthop Traumatol Surg Res, 2016, 102(8):1087-1091.DOI:10.1016/j.otsr.2016.09.006.
[7] Paulos L, Coleman SS, Samuelson KM.Pes cavovarus.Review of a surgical approach using selective soft-tissue procedures[J].J Bone Joint Surg Am, 1980, 62(6):942-953.
[8] Ward CM, Dolan LA, Bennett DL, et al.Long-term results of reconstruction for treatment of a flexible cavovarus foot in Charcot-Marie-Tooth disease[J].J Bone Joint Surg Am, 2008, 90(12):2631-2642.DOI:10.2106/JBJS.G.01356.
[9] Mubarak SJ, Van Valin SE.Osteotomies of the foot for cavus deformities in children[J].J Pediatr Orthop, 2009, 29(3):294-299.DOI:10.1097/BPO.0b013e31819aad20.
[10] Mann DC, Hsu JD.Triple arthrodesis in the treatment of fixed cavovarus deformity in adolescent patients with Charcot-Marie-Tooth disease[J].Foot Ankle, 1992, 13(1):1-6.DOI:10.1177/107110079201300101.
[11] Pareyson D, Marchesi C.Diagnosis, natural history, and management of Charcot-Marie-Tooth disease[J].Lancet Neurol, 2009, 8(7):654-667.DOI:10.1016/S1474-4422(09)70110-3.
[12] Aktas S, Sussman MD.The radiological analysis of pes cavus deformity in Charcot-Marie-Tooth disease[J].J Pediatr Orthop B, 2000, 9(2):137-140.DOI:10.1097/01202412-200004000-00012.
[13] Pfeffer GB, Michalski MP, Basak T, et al.Use of 3d prints to compare the efficacy of three different calcaneal osteotomies for the correction of heel varus[J].Foot Ankle Int, 2018, 39(5):591-597.DOI:10.1177/1071100717753622.
[14] Wetmore RS, Drennan JC.Long-term results of triple arthrodesis in Charcot-Marie-Tooth disease[J].J Bone Joint Surg Am, 1989, 71(3):417-422.
Memo
收稿日期:2021-08-16。
基金项目:北京市属医院科研培育计划项目（PX20210402）
通讯作者:杨征,Email:yzhg816@126.com