Sebastián Drago Perez MD1,2 and Cristian Ortiz Mateluna MD3 1Department of Orthopedic Surgery, Hospital del Trabajador, Santiago, Chile 2Faculty of Medicine, Universidad de los Andes, Santiago, Chile 3Foot and Ankle Center, Orthopedic Department, Clínica Universidad de los Andes, Santiago, Chile Lateral ligament instability, foot drop, and/or Achilles tendon tightness can be manifestations of CMT disorders which conventionally are referred for physiotherapy. Physiotherapy is a simple intervention that may be useful to improve the function of CMT patients. Lindeman et al. found in their RCT that a strengthening program directed to proximal musculature improves strength and functional performance in patients with CMT.1,2 This study completed 24 weeks of follow‐up (level I). Rose et al., also in an RCT, reported an improvement of dorsiflexion range with serial night casting over four weeks.3 Following those four weeks, the patients performed gentle stretching exercises and maintained the dorsiflexion range obtained. This study was conducted in CMT patients (level I). El Mhandi et al., in a cohort study, showed that a 24‐week interval‐training stationary bike program performed three times per week was well tolerated by all patients.4 In addition, it was significantly beneficial to their subjective perception of pain/fatigue; improved the functional capacity of these CMT patients; and although there was no reduced fatigability when tested in isometric mode, all patients increased their dynamic strength and physiological capacities (level II). Chetlin et al., in a retrospective analysis of an RCT, found that a progressive resistance training program improved strength and activities of daily living in patients with CMT.5 This study is important because it shows that patients with CMT can improve significantly with a simple, cost‐effective, and home‐based program (level II). Most authors recommend using PL to PB tendon transfer in the surgical treatment of cavovarus foot to correct forefoot pronation, reduce the first ray plantarflexion and reinforce the weak eversion of the hindfoot.7,8 The PL to PB transfer usually requires side‐to‐side tenorrhaphy, as this is stronger than Pulvertaft weave technique.9
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Cavovarus Foot
Clinical scenario
Top three questions
Question 1: In patients with cavovarus foot and Charcot‐Marie‐Tooth (CMT), does physiotherapy result in better functional scores compared to no physiotherapy?
Rationale
Clinical comment
Available literature and quality of evidence
Findings
Resolution of the clinical scenario
Question 2: In patients undergoing peroneus longus (PL) to peroneus brevis (PB) tendon transfer, does running locked suture result in improved construct strength compared to vertical mattress sutures?
Rationale