Cavovarus foot in children: evaluation of deformity and choice of treatment

Objective To precisely assess the deformity of cavovarus foot in children for selecting individualized procedures. Methods A total of 27 surgical patients with 41 cavovarus feet were reviewed. Their average age was 11.3(7.1-14.5) years. The surgical indications included pains, frequent ankle sprains and shoe-wearing problem. And the findings of medical history, neurologic evaluations and symptoms/signs of foot were recorded. The Coleman block test was used to determine the flexibility of hindfoot. Weight-bearing anteroposterior and lateral radiographs and Coleman block view radiographs of feet were taken to assess the component and apex of deformity. And the results were classified by Wicart grading system. Results All foot deformities were acquired. And 80%(33/41) of them were associated with neurologic disease. Cavus deformity was located at the first metatarsal in 12 feet undergoing first metatarsal dorsiflexion osteotomy(M1-DFO) at medial column in 16 feet with M1-DFO and opening plantar wedge osteotomy of cuneiform, at midfoot in 13 feet with midfoot osteotomy. The plantar release and cuboid closing wedge osteotomy were performed in all 41 feet. The fixed varus of calcaneus was found in 18 feet with calcaneal valgus osteotomy. Muscle balance was restored by anterior transfer of posterior tibialis in 21 feet and peroneus longus to brevis tendon transfer in 15 feet. The average follow-up was 28(6-51) months. And the results were graded as excellent in 34 feet and fair in 7 feet. Conclusions Pediatric cavovarus foot is an acquired deformity with an abnormal elevation of sole tripod and concurrent neurologic diseases. And satisfactory outcomes may be obtained by careful foot examinations and optimal operations. Key words: Clubfoot; Assessment; Treatment