Forefoot-Driven Cavovarus Deformity

Macalus Hogan

Forefoot Deformity

Preoperative Evaluation

Neurologic assessment
Coleman block testing determines forefoot versus hindfoot deformity.
- Failure to achieve deformity correction on x-ray when positioning lateral foot/hindfoot on 1-cm block suggests fixed deformity (Figure 7-1).
Assess muscle imbalance that may contribute to recurrence.

Positioning

Supine on the table with heel near the end of the table
Hip bump placed under the ipsilateral side with foot perpendicular to the floor
Thigh tourniquet with padding to prevent skin breakdown/injury
Bone foam or sterile bump (optional, but may permit improved exposure of the medial aspect of the foot)

Figure 7-1. A, Create a 3- to 4-cm incision over the insertion of the posterior tibial tendon (PTT) on the navicular bone. B, Dissect through subcutaneous tissue to expose the flexor retinaculum and PTT sheath.

Surgical Approach

Technique No. 1—Posterior tibial tendon (PTT) transfer
- Create a 3- to 4-cm incision over the insertion of the PTT on the navicular bone.
- Dissect through subcutaneous tissue.
- Incise the flexor retinaculum and PTT sheath.
- With an Overholt clamp, tension the tendon to release from the insertion site with a scalpel as far distal as possible.
- Incise another 3-cm site at the distal aspect of the medial leg, but three fingerbreadths above the ankle.
- Dissect through the subcutaneous tissue.
- Incise the fascia and retract with Langenback retractors.
- Identify the flexor hallux longus (FHL) and retract the tendon to visualize the PTT just deep to the FHL tendon.
- Pull the PTT tendon into view to bisect the tendon.
  
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