Individuals with a very high arch (cavus foot) may suffer from one of a number of neurological disorders such as Charcot Marie Tooth (CMT) sensory motor neuropathy. Foot deformities are caused by a muscle imbalance in the leg and foot and usually get progressively worse over time. Eventually the foot deformities may require surgical correction although special orthotics and braces may be useful in the early phases of this disorder. It is important that medical advice is sought before deformities become severe as surgical options often become limited. Ideally surgery should aim to correct the foot deformities and to improve the muscle imbalance that caused them. Often deformities can be corrected without stiffening the foot although, for severe deformities fusion of joints in the hindfoot may be required.
Case - 1
Preoperative photograph of a patient with Charcot-Marie-Tooth disease with a high arched foot causing recurrent giving way of the ankle
Preoperative x-ray of the patient's foot and ankle
X-ray of the same foot following reconstructive, joint preserving surgery. Special bone screws and a plate have been used to hold the bones together during the healing phase
Case - 2
This is picture of a patient with a significant cavo-varus deformity. In this case the joints below the ankle are affected as well as the ankle itself. The long standing deformity has lead to severe arthritis in the ankle joint
Correction of such significant deformities requires appreciation of the joints involved while trying to minimise residual stiffness of the foot after surgery. This X-ray shows that the patient required an arthrodesis (fusion) of both the ankle and Subtalar joints – a tibio-talar-calcaneal fusion. Solid internal fixation with a blade plate and screws was crucial to reduce the chance of failure of fusion (non-union)
This X-ray (side view) demonstrates the internal fixation with the plate and screws more clearly
