Operative Orthopädie und Traumatologie

, Volume 30, Issue 2, pp 130–146 | Cite as

Operative treatment algorithm for foot deformities in Charcot-Marie-Tooth disease

Surgical Techniques
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Abstract

The present article presents a short summary concerning the pathomechanisms and clinical presentation of foot deformities in Charcot-Marie-Tooth syndrome. Furthermore, a classification system is introduced and based on a recently performed review of the literature an operative treatment algorithm is provided. The operative technique of the following surgical procedures is described in more detail: 1. dorsiflexion osteotomy at the base of the 1st metatarsus, 2. dorsiflexion osteotomy at the base of a lesser metatarsal bone, 3. claw hallux correction including fusion of the first phalangeal joint, 4. claw toe correction, 5. transfer of extensor digitorum longus tendons to the peroneal tendons and finally 6. tibialis posterior tendon transfer to the dorsiflexors of the foot.

Keywords

Tendon transfer Classification system Osteotomy Claw hallux Claw toe 

Algorithmus für die operative Behandlung von Fußdeformitäten bei der Charcot-Marie-Tooth-Krankheit

Zusammenfassung

Der vorliegende Beitrag bietet eine kurze Zusammenfassung der Pathomechanismen und des klinischen Bilds von Fußdeformitäten bei der Charcot-Marie-Tooth-Krankheit. Ein Klassifikationssystem wird vorgestellt. Basierend auf einer kürzlich durchgeführten Literaturübersicht wird ein Algorithmus für die operative Behandlung vorgeschlagen. Die operativen Techniken folgender chirurgischer Verfahren werden detaillierter beschrieben: 1. Dorsalflexionsosteotomie an der Basis des ersten Mittelfußknochens, 2. Dorsalflexionsosteotomie an der Basis eines der anderen Mittelfußknochen, 3. Korrektur einer Krallenstellung der Großzehe einschließlich Fusion des ersten Phalangealgelenks, 4. Korrektur einer Krallenzehe, 5. Extensor-digitorum-longus-Transfer zu den Peronealsehnen und zuletzt 6. Transfer der Tibialis-posterior-Sehne zu den Dorsiflexoren des Fußes.

Schlüsselwörter

Sehnentransfer Klassifikationssystem Osteotomie Krallen hallux Krallenzehe 

Notes

Acknowledgements

Gratitude to Rudolf Stienstra (head of department of Anaesthesiology, St. Maartenskliniek, Nijmegen, NL) for writing the section concerning anaesthesia and to the colleagues of the Dutch guidelines study group, Viola Altmann (rehabilitation doctor) and the researchers Noël Keijsers and Cheriel Hofstad. Finally, my scrub nurse Birgitta van Cuyk-Kampschreur. All working at the St. Maartenskliniek, Nijmegen, NL.

Compliance with ethical guidelines

Conflict of interest

J.W.K. Louwerens declares that he has no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Barton T, Winson I (2013) Joint sparing correction of cavovarus feet in Charcot-Marie-Tooth disease; what are the limits? Foot Ankle Clin 18:673–688CrossRefPubMedGoogle Scholar
  2. 2.
    Beals TC, Nickisch F (2008) Charcot-Marie-Tooth disease and the cavovarus foot. Foot Ankle Clin 13:259–274CrossRefPubMedGoogle Scholar
  3. 3.
    Breusch SJ, Wenz W, Döderlein L (2000) Function after correction of a clawed great toe by a modified Robert Jones transfer. J Bone Joint Surg Br 82:250–254CrossRefPubMedGoogle Scholar
  4. 4.
    Chan G, Sampath J, Miller F et al (2007) The role of the dynamic pedobarograph in assessing treatment of cavovarus feet in children with Charcot-Marie-Tooth disease. J Pediatr Orthop 27:510–516CrossRefPubMedGoogle Scholar
  5. 5.
    Colofon, Richtlijn HMSN © 2017, Spierziekten Nederland, Luitenant general van Heutszlaan 6, 3743JN Baarn, www.spierziekten.nl
  6. 6.
    Dreher T, Wolf SI, Heitzmann D, Fremd C, Klotz MC, Wenz W (2014) Tibialis posterior tendon transfer corrects the foot drop component of cavovarus foot deformity in Charcot-Marie-Tooth disease. J Bone Joint Surg Am 96:456–462CrossRefPubMedGoogle Scholar
  7. 7.
    Faldini C, Traina F, Nanni M et al (2015) Surgical treatment of cavus foot in Charcot-Marie-Tooth disease: a review of twenty-four cases: AAOS exhibit selection. J Bone Joint Surg Am 97:e30CrossRefPubMedGoogle Scholar
  8. 8.
    Hansen ST Jr (2000) Functional reconstruction of the foot and ankle. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  9. 9.
    Hebl JR, Horlocker TT, Schroeder DR (2006) Neuraxial anesthesia and analgesia in patients with preexisting central nervous system disorders. Anesth Analg 103:223–228CrossRefPubMedGoogle Scholar
  10. 10.
    Holmes JR, jr. Hansen ST (1993) Foot and ankle manisfestations of Charcot-Marie-Tooth disease. Foot Ankle Int 4:476–486CrossRefGoogle Scholar
  11. 11.
    Karlholm S, Nilsonne U (1968) Operative treatment of the foot deformity in Charcot-Marie-Tooth disease. Acta Orthop Scand 39:101–106CrossRefPubMedGoogle Scholar
  12. 12.
    Krause FG, Iselin LD (2012) Hindfoot varus and neurologic disorders. Foot Ankle Clin 17:39–56CrossRefPubMedGoogle Scholar
  13. 13.
    Leeuwesteijn AEEPM, de Visser E, Louwerens JWK (2010) Flexible cavovarus feet in Charcot-Marie-Tooth disease treated with first ray proximal dorsiflexion osteotomy combined with soft tissue surgery: a short-term to mid-term outcome study. Foot Ankle Surg 16:142–147CrossRefPubMedGoogle Scholar
  14. 14.
    Martyn CN, Hughes RA (1997) Epidemiology of peripheral neuropathy. J Neurol Neurosurg Psychiatr 62:310–318CrossRefGoogle Scholar
  15. 15.
    Metaxiotis D, Accles W, Pappas A, Döderlein L (2000) Dynamic pedobarography (DPB) in operative management of cavovarus foot deformity. Foot Ankle Int 21:935–947CrossRefPubMedGoogle Scholar
  16. 16.
    Miller GM, Hsu JD, Hoffer MM, Rentfro R (1982) Posterior tibial tendon transfer: a review of the literature and analysis of 74 procedures. J Pediatr Orthop 2:363–370CrossRefPubMedGoogle Scholar
  17. 17.
    Napiontek M, Pietrzak K (2015) Joint preserving surgery versus arthrodesis in operative treatment of patients with neuromuscular polyneuropathy: questionnaire assessment. Eur J Orthop Surg Traumatol 25:391–397CrossRefPubMedGoogle Scholar
  18. 18.
    Olney B (2000) Treatment of the cavus foot. Deformity in the pediatric patient with Charcot-Marie-Tooth. Foot Ankle Clin 5:305–315PubMedGoogle Scholar
  19. 19.
    Ortiz C, Wagner E (2014) Tendon transfers in cavovarus foot. Foot Ankle Clin 19:49–58CrossRefPubMedGoogle Scholar
  20. 20.
    Roper BA, Tibrewal SB (1989) Soft tissue surgery in Charcot-Marie-Tooth disease. J Bone Joint Surg Br 71:17–20CrossRefPubMedGoogle Scholar
  21. 21.
    Roy DR, Al-Sayyad MJ (2001) Complications of surgery of the foot and ankle in hereditary neurologic disorders. Clin Orthop Relat Res 391:181–187CrossRefGoogle Scholar
  22. 22.
    Saltzman CL, Fehrle MJ, Cooper RR et al (1999) Triple arthrodesis: twenty-five and forty-four-year average follow-up of the same patients. J Bone Joint Surg Am 81:1391–1402CrossRefPubMedGoogle Scholar
  23. 23.
    Sammarco GJ, Taylor R (2001) Cavovarus foot treated with combined calcaneus and metatarsal osteotomies. Foot Ankle Int 22:19–30CrossRefPubMedGoogle Scholar
  24. 24.
    Santavirta S, Turunen V, Ylinen P et al (1993) Foot and ankle fusions in Charcot-Marie-Tooth disease. Arch Orthop Trauma Surg 112:175–179CrossRefPubMedGoogle Scholar
  25. 25.
    Wagenaar FCBM, Louwerens JWK (2007) Technique tip: handling of the soft tissues of the anterior compartment in posterior tibial tendon transfer to the dorsiflexors proximal to the ankle joint. Foot Ankle Int 28:1204–1206CrossRefPubMedGoogle Scholar
  26. 26.
    Ward CM, Dolan LA, Bennett DL et al (2008) Long-term results of reconstruction for treatment of a flexible cavovarus foot in Charcot-Marie-Tooth disease. J Bone Joint Surg Am 90:2631–2642CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Wetmore RS, Drennan JC (1989) Long-term results of triple arthrodesis in Charcot-Marie-Tooth disease. J Bone Joint Surg Am 71:417–422CrossRefPubMedGoogle Scholar
  28. 28.
    Wicart P (2012) Cavus foot, from neonates to adolescents. Orthop Traumatol Surg Res 98:813–828CrossRefPubMedGoogle Scholar
  29. 29.
    Yagerman SE, Cross MB, Green DW, Scher DM (2012) Pediatric orthopedic conditions in Charcot–Marie–Tooth disease: a literature review. Curr Opin Pediatr 24:50–56CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Foot and Ankle Reconstruction UnitSt MaartenskliniekNijmegenThe Netherlands

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