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Review Question - QID 194

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QID 194 (Type "194" in App Search)
A 42-year-old woman with Charcot-Marie-Tooth disease complains of longstanding foot pain. Orthotics, bracing, and NSAIDs no longer provide relief. She has cavovarus hindfoot deformity that does not correct with Coleman block testing. Radiographs are notable for degenerative changes within the talocalcaneal and calcaneocuboid joints. Which of the following is the most appropriate treatment?

Split tibialis posterior transfer

1%

20/2020

Triple arthrodesis

82%

1651/2020

Lateral closing wedge calcaneal osteotomy with peroneus longus to brevis transfer

14%

286/2020

First metatarsal dorsal closing wedge osteotomy

1%

26/2020

Achilles tendon lengthening

1%

23/2020

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Charcot-Marie-Tooth disease is also known as hereditary motor sensory neuropathy. Characteristic deformity occurs when the weakened peroneal brevis and anterior tibalis succumb to the stronger posterior tibialis and peroneus longus resulting in a cavovarus foot. Coleman block testing is used to determine whether the deformity is flexible or rigid. An example of a correctable deformity is provided in Illustration A. Once the foot has become rigid and begins developing arthritic changes, triple arthrodesis is indicated. Flexible deformities without arthritic changes may be amenable to tendon transfers and dorsiflexion osteotomy of the first ray. Holmes et al reviews the evaluation, diagnosis, and treatment of the cavovarus foot in Charcot-Marie-Tooth disease.

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