ArticleJBJS essential surgical techniques
Calcaneo-Cuboid-Cuneiform Osteotomy for the Treatment of Planovalgus Feet in Patients with Spastic Cerebral Palsy.
Article in JBJS essential surgical techniques. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The calcaneo-cuboid-cuneiform (triple-C) osteotomy is indicated for the correction of symptomatic flexible planovalgus foot deformity. This procedure allows correction of all of the varied components of the planovalgus foot deformity in a single operation Description: The patient is positioned in a floppy lateral position Alternatives: If the feet are supple enough to allow passive correction, an in-socket ankle-foot orthosis with a medial arch support can be utilized to maintain the shape of the foot and to delay deterioration and the need for surgery Rationale: The triple-C osteotomy is straightforward and has a short learning curve. There is no need for bone-graft harvesting and the associated morbidity thereof. Studies have shown minimal complications and low long-term recurrence with use of the triple-C osteotomy in patients with spastic cerebral palsy Expected Outcomes: We have reported on the short-term outcomes of this procedure Important Tips: Protect the sural nerve during calcaneal exposure.Osteotomize the medial cortex of the calcaneus with use of an osteotome in order to avoid injuring the medial neurovascular structures.Avoid violating the adjacent joints when performing the cuboid and cuneiform osteotomies.The wedge of bone harvested from the medial cuneiform should be excised in toto to effectively lengthen the cuboid.If utilized, cannulated cancellous screws should be countersunk in the posterior cortex of the calcaneus to prevent irritation. Acronyms and Abbreviations: AFO = ankle-foot orthosisUCBL = University of California Biomechanics LaboratoryCP = cerebral palsyAP = anteroposteriorVAS = visual analog scoreCC screws = cannulated cancellous screws.
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