Two-stage corrective operation for the treatment of pes cavovarus in patients with spina bifida

BACKGROUND Pes cavovarus has an estimated incidence of 8%-17%in patients with spina bifida(SB).The majority of the current literature on surgical treatment of cavovarus feet in children and adolescents includes a variety of diagnoses.There are currently no case series describing a treatment algorithm for deformity correction in this specific patient population.The authors of this study present the results of a retrospective case series performed to assess the radiographic outcomes of two-stage corrective surgery in patients with SB.METHODS Retrospective chart review was performed on patients with SB with a diagnosis of pes cavovarus at a freestanding children’s hospital who underwent surgical correction of the deformity.Patients were excluded for lack of two-stage corrective operation,nonambulatory status,lack of at least six months follow-up,and age>18 years at the time of surgery.This resulted in a cohort of 19 patients.Radiographic analysis was performed on 11 feet that had a complete series of preoperative and postoperative weightbearing X-rays.Preoperative and postoperative radiographic outcome measurements were compared using a two-sample t-test.RESULTS Significant changes between the preoperative and postoperative measurements were seen in Meary’s angle,the anteroposterior talo-first metatarsal(AP TMT1)angle,and the talonavicular coverage.Mean values of Meary’s angle were 17.9±13.1 preoperatively and 4.7±10.3 postoperatively(P=0.016).Mean AP TMT1 angle was 20.6±15.1 preoperatively and 9.3±5.5 postoperatively(P=0.011).Mean talonavicular coverage values were-10.3±9.6 preoperatively and-3.8±10.1 postoperatively(P=0.025).CONCLUSION The two-stage corrective procedure demonstrated efficacy in correcting cavovarus deformity in patients with SB.Providers should strongly consider employing the staged surgical algorithm presented in this manuscript for management of these patients.