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Percutaneous Correction of Persistent Severe Metatarsus Adductus in Children

Knörr, Jorge MD*; Soldado, Francisco MD, PhD; Pham, Thuy T. MD*; Torres, Ana MD; Cahuzac, Jean P. MD, PhD*; de Gauzy, Jérôme Sales MD, PhD*

Journal of Pediatric Orthopaedics: June 2014 - Volume 34 - Issue 4 - p 447–452
doi: 10.1097/BPO.0000000000000122
Foot & Ankle

Background: Percutaneous techniques for the correction of foot deformities are gaining popularity in the adult population, but remain poorly explored in children. Of the several surgical techniques described to treat persistent severe metatarsus adductus (MA) deformity in children, neither was percutaneous. The purpose of the study was to describe a percutaneous technique for MA correction in children, to report the outcomes, and to discuss the advantages it offers.

Methods: We designed a prospective study on 34 consecutive feet with MA deformity from 26 children undergoing percutaneous correction. All operated feet had severe, rigid MA deformities, most of which were components of residual/recurrent clubfoot deformities. The mean age at surgery was 5.7 years and the mean follow-up was 55.2 months. For clinical evaluation, we used the bisector method; the first cuneometatarsal angle and metatarsal-metaphyseal angle measured in weight-bearing radiographs and AOFASf score were determined preoperatively and postoperatively. In unilateral cases, we used the contralateral foot measurements as control. The operating time and the hospitalization time were also recorded. The surgical technique consisted of performing the Cahuzac procedure for MA correction with a percutaneous approach.

Results: At the final follow-up all feet presented a normal heel bisector line. Radiologic parameters were normalized when compared with control feet. The mean surgical and hospitalization time was 14 minutes and 6 hours, respectively. Mean AOFAS score improved from 78 to 98.

Conclusions: A minimally invasive percutaneous technique allowed a successful correction of MA deformity in children and resulted in a substantive decrease in both surgical and hospitalization time and better cosmetic results.

Level of Evidence: Level II.

*Pediatric Orthopedic Surgery Department, Hôpital des Enfants, CHU Toulouse, Toulouse, France

Pediatric Upper Limb and Microsurgery, VHIR, Universitat Autònoma de Barcelona

Orthopedic Surgery Department, Hospital Universitario Santa Lucía, Cartagena, Spain

Study conducted at the Pediatric Orthopedic Surgery Department, Hôpital des Enfants, CHU Toulouse, 330-Avenue de Grande Bretagne, 31059 Toulouse, France.

The authors declare no conflicts of interest.

Reprints: Jorge Knörr, MD, Pediatric Orthopedic Surgery Department, Hôpital des Enfants, CHU Toulouse, 330-Avenue de Grande Bretagne, TSA 70034, 31059 Toulouse Cedex 9, France. E-mail: knorr.j@chu-toulouse.fr.

© 2014 by Lippincott Williams & Wilkins