Surgical Treatment of Adult Idiopathic Cavus Foot with Plantar Fasciotomy, Naviculocuneiform Arthrodesis, and Cuboid Osteotomy by Sandro Giannini, Francesco.

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Surgical Treatment of Adult Idiopathic Cavus Foot with Plantar Fasciotomy, Naviculocuneiform Arthrodesis, and Cuboid Osteotomy by Sandro Giannini, Francesco Ceccarelli, Maria Grazia Benedetti, Cesare Faldini, and Gianluca Grandi J Bone Joint Surg Am Volume 84(suppl 2):S62-S69 November 1, 2002 ©2002 by The Journal of Bone and Joint Surgery, Inc.

The typical morphologic appearance of a cavus foot. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Mechanical model of the foot in which the balance of muscles, soft tissues, and bones maintains the normal anatomy and function. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

When the balance is disturbed because of weakness of the tibialis anterior muscle, the foot becomes deformed as a whole, producing a cavus deformity. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

In the case of a more rigid anterior cavus deformity, the difference in level between hindfoot and forefoot during weight-bearing is compensated by a talus position of the talocrural joint. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

The anterior (widest) part of the talar body is positioned in the tibiofibular mortise by the talar position of the ankle joint, causing continual stretching of the distal tibiofibular ligament. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

After plantar fasciotomy, the naviculocuneiform arthrodesis and cuboid osteotomy are performed. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Radiograph illustrating the arch angle measurement. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Radiograph illustrating the calcaneal pitch measurement. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Radiograph illustrating the tibiotalar angle measurement. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

The open plantar fasciotomy is performed through a medial approach. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Before correction of the deformity, the hindfoot is realigned and fixed with a 2.5-mm Kirschner wire that crosses the subtalar and ankle joints. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Illustration of the medial surgical field. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Illustration depicting the resection arthrodesis of the naviculocuneiform joint. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Illustration of the lateral surgical field, depicting the resection of a superolateral wedge from the cuboid bone. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

The deformity is corrected by closing and fixing the medial and lateral gaps, resulting in an improved range of motion of the ankle joint. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Clinical results: ankle dorsiflexion. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Clinical results: ankle plantar flexion. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Clinical results: heel varus. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Figs. 19-A and 19-B A thirty-year-old man with ICF was managed with plantar fasciotomy, naviculocuneiform arthrodesis, and cuboid osteotomy. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Radiographs made before surgery (left) and four years after surgery (right). Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Figs. 20-A and 20-B A twenty-five-year-old man with ICF was managed with plantar fasciotomy, naviculocuneiform arthrodesis, and cuboid osteotomy combined with a modified Jones procedure. Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Radiographs made before surgery (left) and five years after surgery (right). Sandro Giannini et al. J Bone Joint Surg Am 2002;84:S62- S69 ©2002 by The Journal of Bone and Joint Surgery, Inc.