An Algorithm to Assist the Surgical Decision Making in the Operative Management of the Cavovarus Foot

Abstract

Category: Hindfoot Introduction/Purpose: The cavovarus foot is a complex deformity caused by muscle imbalance, soft-tissue contracture and secondary bony abnormality. It is a combination of hindfoot, midfoot and forefoot deformity and the decision making process for surgical management can be difficult. The process of deciding which combination of procedures is required is often poorly understood. We present an algorithm to assist with this decision making. Methods: We have analyzed a single surgeon's experience of cavovarus foot correction, from a consecutive series of 60 patients over 6 years, to develop an algorithm to guide operative decision making. Cases included cavovarus deformity secondary to cerebral palsy, Frie-dreich's ataxia, Charcot Marie Tooth disease, post-traumatic contracture, post-cerebrovascular accident, iatrogenic post-surgery and physiological cavus. We have taken a systematic appr oach to each component of the deformity in order to generate the algorithm. Results: To assist in rationalizing the traditional ‘a-la-carte’ approach, our algorithm describes what we believe are the indications for a variety of surgical interventions, including soft tissue contracture release, osteotomies of the hindfoot, midfoot and forefoot, tendon transfer and soft tissue balancing, and arthrodesis. We detail the decision making process for each surgical option and give the reasons for each decision. We have also reviewed the available literature on this topic, to produce an evidence-based and useable means of surgical planning. Conclusion: The surgical decision making process in the management of the cavovarus foot is complex. We believe that this algorithm, based on extensive personal experience and up-to-date published evidence, provides a clear and proven framework on which surgical decision making can be guided and justified.