Is non-operative management of childhood neurologic cavovarus foot effective?

Abstract Introduction Neurologic pes cavus is a progressive deformity that is difficult to treat during growth. The present study reports results of non-operative management, based on the pathophysiology of the deformity, by untwisting nocturnal splint, preceded in some cases by untwisting walking c...

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Published in:Orthopaedics & traumatology, surgery & research surgery & research, 2016-12, Vol.102 (8), p.1087-1091
Main Authors: d’Astorg, H, Rampal, V, Seringe, R, Glorion, C, Wicart, P
Format: Article
Language:English
Subjects:
Adolescent
Age Factors
Casts, Surgical
Charcot-Marie-Tooth Disease - complications
Child
Child, Preschool
Disease Progression
Female
Follow-Up Studies
Gait - physiology
Humans
Male
Neurologic cavovarus foot
Non-operative treatment
Orthopedics
Patient Compliance
Retrospective Studies
Splint
Splints
Surgery
Talipes Cavus - etiology
Talipes Cavus - physiopathology
Talipes Cavus - therapy
Treatment Outcome
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Summary:Abstract Introduction Neurologic pes cavus is a progressive deformity that is difficult to treat during growth. The present study reports results of non-operative management, based on the pathophysiology of the deformity, by untwisting nocturnal splint, preceded in some cases by untwisting walking cast. The objective was to assess efficacy and impact on indications for surgery. Method Twenty-three children (35 feet) were included. All had neurologic cavovarus foot, which was progressive in 24 feet (69%) (Charcot-Marie-Tooth disease). Mean age at initiation of treatment was 8.8 years. In 13 feet (38%), treatment began with a untwisting walking cast and in 22 (62%) began directly with the splint. Results Mean follow-up was 4.5 years. Fifteen feet showed very good and 8 good clinical results (65%); 9 children (12 feet) had moderate or poor results, requiring renewed treatment in 11 feet at a mean 4.5 years after initiation of non-operative treatment. Thirteen patients (56.5%, 21 feet) had reached end of growth by last follow-up; 10 of these feet (48%) had good or very good results without surgery. No triple arthrodeses were required. Factors weighing against good outcome comprised young age at treatment initiation and poor compliance with the splint. Primary deformity severity did not affect outcome. Conclusion The present study demonstrated efficacy for non-operative treatment of childhood neurologic cavovarus foot. Surgery was either avoided (in half of the cases followed up to end of growth) or delayed by a mean 4.5 years, allowing a single procedure before end of growth. We recommend initiating non-operative treatment of childhood cavovarus foot, associating untwisting walking cast and untwisting nocturnal splint, as soon as clinical progression is detected and/or Méary angle on lateral X-ray with block reaches 15°. Level of evidence IV.
ISSN:1877-0568
1877-0568
DOI:10.1016/j.otsr.2016.09.006