Joint preservation surgery for correction of flexible pes cavovarus in adults

Cavovarus foot deformity often results from muscular imbalance. If deformities are still flexible, surgical correction can be aimed primarily at improving muscular balance.

We retrospectively assessed the outcome of 19 procedures (in 15 patients) to evaluate patient satisfaction. All patients had a flexible deformity. The surgical procedures that were used included soft-tissue releases, tendon transfers and lengthenings, and osteotomies of either the first metatarsal or the calcaneus. The surgical results in terms of pain, function and alignment of the foot were evaluated by means of standardized questionnaire (AOFAS foot score and the Dutch version of the Foot Function Index), patient interview, physical examination and X-ray. The changes in calcaneal pitch and talus-metatarsal I angle were calculated.

Overall patient satisfaction was good. The results were very satisfactory in five procedures, satisfactory in ten, moderately satisfactory in two, unsatisfactory in one, and very unsatisfactory in one procedure. The AOFAS hindfoot score was on average 82.5 +/- 16. The talus-metatarsal I angle significantly decreased from 22.5 to 17 degrees (p = 0.002). The anatomical corrections of the foot did not show association with the patients' clinical characteristics.

Our results show that in joint preserving flexible pes cavovarus correction patient satisfaction is generally good. Radiographic alignment of the foot was not significantly associated with patient-based outcome in this small series of patients.