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Review Question - QID 6715

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QID 6715 (Type "6715" in App Search)
A 17-year-old girl with Charcot-Marie-Tooth disease reports the development of progressive instability when walking on uneven surfaces. Her involved heel is positioned in varus when viewed from behind. Examination reveals that she walks on the outer border of the involved foot. She has full passive motion of the ankle and hindfoot joints. She is able to dorsiflex the ankle against resistance. The heel varus fully corrects with the Coleman block test. Standing radiographs reveal a cavus deformity with valgus of the forefoot. She would like to avoid using an ankle-foot orthosis. What is the best surgical option?

Dorsiflexion osteotomy of the first metatarsal

31%

94/308

Dorsiflexion osteotomy of the first metatarsal combined with anterior transfer of the tibialis posterior

37%

115/308

Triplanar osteotomy at the apex of the deformity

4%

11/308

Triplanar osteotomy at the apex of the deformity combined with valgus calcaneal osteotomy

12%

36/308

Triplanar osteotomy at the apex of the deformity combined with anterior transfer of the tibialis posterior

15%

47/308

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This deformity is early in the disease process. The foot is still flexible, as evidenced by correction with the Coleman block test. A simple dorsiflexion osteotomy of the first metatarsal should provide a plantigrade foot. More complex osteotomies are required later in the disease process when the foot is not flexible and the deformity does not correct with the Coleman block test. The patient may also require a tibialis anterior transfer later in the disease process but not at the present time.

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