Hindfoot-Driven Cavovarus Deformity
Macalus Hogan
Hindfoot Deformity
Preoperative Evaluation
Patient history and physical
In cases of a tight Achilles tendon, a lengthening procedure or gastrocnemius recession should be performed before any osteotomy procedure.
This will reduce deforming forces on the heel.
Preoperative radiographic analysis critical to surgical indication and determination (Figure 8-1)
Visual inspection and gait analysis
Motor and neurologic assessment
Compare to contralateral extremity
Perform Coleman block testing: determine the presence of fixed hindfoot deformity, thereby warranting additional surgical correction1 (Figure 8-2).
Place patient’s heel and lateral foot onto a 2.5-cm block, permitting the first to fourth metatarsals (MTs) to fall into pronation.
Block size may be increased to reduce weight-bearing impact of first MT.
Obtain anteroposterior (AP) and lateral x-rays to document deformity changes with block.
Document and prioritize muscle imbalances that contribute to deformity recurrence.
Surgical Planning and Sterile Instruments/Equipment
Radiolucent operating room table
C-arm flouroscopy
Thigh tourniquet
Figure 8-1. Preoperative lateral radiograph demonstrates moderate cavovarus deformity with early degenerative changes.
Figure 8-2. Coleman block testing used to determine the presence of flexible versus fixed hindfoot deformity.
#15 blade
Small Hohmann retractors
Narrow sagittal saw
Kirschner wires (1.6- or 2.0-mm K-wires)
Implants
6.5- or 6.7-mm partially threaded cancellous screws
Rasp
Smooth-toothed calcaneal laminar spreader
Joker and/or Freer elevator
Sutures (nonabsorbable)
Positioning/Prep
Visually inspect surgical leg in preoperative area.
Confirm there are no active ulcers/infections.
Mark the operative extremity.
Preoperative ankle block with 1% lidocaine and 0.5% bupivacaine typically adequate for hindfoot procedure
Position patient supine on the table.
Heel should be positioned near the end of the table.
Place a bump (centered at the level of anterior superior iliac spine [ASIS]) under the hip of the operative leg to increase foot internal rotation.
May use either bone foam or sterile bump (surgeon preference) to improve access to the medial and lateral aspects of the foot
Well-padded calf tourniquet
Use a plastic shield barrier or foam tape to prevent skin breakdown secondary to retained operative prep.
Surgical Approach
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