Hindfoot-Driven Cavovarus Deformity



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.




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.

Dec 14, 2019 | Posted by in ORTHOPEDIC | Comments Off on Hindfoot-Driven Cavovarus Deformity

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