JOURNAL ARTICLE

The role of the dynamic pedobarograph in assessing treatment of cavovarus feet in children with Charcot-Marie-Tooth disease

Gilbert Chan, Jayanth Sampath, Freeman Miller, Eric C Riddle, Mary K Nagai, S Jay Kumar
Journal of Pediatric Orthopedics 2007, 27 (5): 510-6
17585258
We used the dynamic pedobarographs to study pressure distribution patterns in the foot after surgical correction of cavovarus feet. We also assessed the influence of ankle power generation on pressure distribution in these feet. Nine children (14 feet) diagnosed with Charcot-Marie-Tooth disease who had undergone operative treatment with a combination of osteotomies and muscle transfers were the subjects of this study. Preoperative and postoperative pedobarographic measurements recorded included pressure over the medial forefoot, lateral forefoot, medial midfoot (MMF), lateral midfoot (LMF), and heel segments. In 6 patients (9 feet) who had a complete gait analysis, the power generation of the ankle was also obtained both preoperatively and postoperatively. Lateral radiographic measurements included the (1) talus-first metatarsal angle, (2) calcaneus-first metatarsal angle, and (3) calcaneal pitch. The radiographs showed significant improvements in all 3 angles. Increased LMF and decreased forefoot pressures were seen on preoperative pedobarographic measures. Postoperatively, improvement in pressure at the LMF was seen. When postoperative measurements were compared with the normal values, only the LMF was similar; the other 4 segments showed decreased forefoot and MMF pressures and increased heel pressures (P = 0.000 for the lateral forefoot and MMF; 0.040 for the heel and medial forefoot). The heel pressures displayed an inverse relationship to ankle power generation. The amount of correction achieved radiographically did not correlate with pedobarographic measurements. The increased heel pressure that was noted was not addressed by treatment. Normalization of pressure patterns should be the goal in treating children with symptomatic cavovarus feet. Although the foot deformity is corrected completely in neuromuscular disorders, pressure distribution was not normalized, and therefore, symptoms might persist. Both patients and parents should be informed about this possible problem before surgical intervention.

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