Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2019; 7(20): 3208-3216
Published online Oct 26, 2019. doi: 10.12998/wjcc.v7.i20.3208
Soft tissue release combined with joint-sparing osteotomy for treatment of cavovarus foot deformity in older children: Analysis of 21 cases
Zhen-Yu Chen, Zhan-Yong Wu, Yue-Hui An, Li-Fei Dong, Jia He, Run Chen
Zhen-Yu Chen, Zhan-Yong Wu, Yue-Hui An, Li-Fei Dong, Jia He, Run Chen, The Ninth Department of Orthopedics, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai 054000, Hebei Province, China
Author contributions: Chen ZY, Wu ZY, An YH, Dong LF, He J, and Chen R designed the research; Chen ZY, Wu ZY, An YH, Dong LF, He J, and Chen R performed the research; He J and Chen analyzed the data; and Chen ZY wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Jizhong Energy Xingtai Mining Group General Hospital.
Informed consent statement: The informed consent was waived by the Ethics Committee, because the use of the data is anonymous.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhen-Yu Chen, PhD, Chief Physician, Department of Orthopedics, Jizhong Energy Xingtai Mining Group General Hospital, 202 Bayi Street, Qiaoxi District, Xingtai 054000, Hebei Province, China. chenzhenyu6666@163.com
Telephone: +86-319-2069485 Fax: +86-319-2069425
Received: May 15, 2019
Peer-review started: May 21, 2019
First decision: July 30, 2019
Revised: September 2, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: October 26, 2019
ARTICLE HIGHLIGHTS
Research background

Cavovarus foot is a common form of foot deformity in children. It can be simultaneously complicated with forefoot pronation and varus, rearfoot varus, Achilles tendon contracture, or cock-up toe deformity. Many diseases can lead to muscle force imbalance. At present, many surgical treatments are available for cavovarus foot. For older children, priority should be given to midfoot osteotomy and fusion. It is important to preserve the joints and correct the deformity as much as possible.

Research motivation

Currently, diverse treatments are available for cavovarus foot, but there is no standard treatment. Improper treatment will lead to residual deformity or recurrence. Therefore, personalized surgical treatment strategies should be formulated based on preoperative assessment of the deformity and muscle force of the affected foot.

Research objectives

This study aimed to assess the efficacy of soft tissue release combined with joint-sparing osteotomy in the treatment of cavovarus foot deformity in older children.

Research methods

Clinical data of 21 older children with cavovarus foot deformity were retrospectively analyzed. The patients underwent magnetic resonance imaging of the lumbar spine, electromyographic examination, weight-bearing anteroposterior and lateral X-rays of the feet, and the Coleman block test. Surgical procedures were performed. Therapeutic effects were evaluated. Meary’s angles and Hibbs’ angles were measured based on X-ray images.

Research results

Very good results were achieved in 18 feet, good in 7, and fair in 3, with a very good/good rate of 89.3%. At last follow-up, mean Meary’s angle was 6.36° ± 1.810°, and mean Hibbs’ angle was 160.21° ± 4.167°, both of which were significantly improved compared with preoperative values. No complications such as infection, skin necrosis, or bone nonunion occurred.

Research conclusions

Soft tissue release combined with joint-sparing osteotomy has appreciated efficacy in the treatment of cavovarus foot deformity in older children, and it can correct the deformity, reduce postoperative recurrence, and preserve the flexibility of the foot as much as possible.

Research perspectives

Although satisfactory efficacy can be achieved by soft tissue release combined with joint-sparing osteotomy in children with cavovarus foot deformity, long-tern follow-up data are needed to confirm our conclusion. Future search should utilize big data analysis to formulate accurate treatment plan to minimize complications while guaranteeing the best therapeutic effect.