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The Akron dome midfoot osteotomy as a salvage procedure for the treatment of rigid pes cavus: a retrospective review.

OBJECTIVE: In the early 1970s, the Akron dome osteotomy was developed as a salvage surgical option to manage rigid cavus deformity of the foot. This study represents an updated review of surgical cases between 1972 and 2001 constituting 89 patients representing 139 feet who were followed at least 2 years after the index operative procedure. Only cases achieving an unsatisfactory result followed less than 2 years were included.

STUDY DESIGN: A retrospective review of cases (all operated by D.S.W.) was conducted by clinical examination and chart review of all 89 cases representing 139 feet.

RESULTS: A satisfactory result was considered pain-free, at least 75% plantigrade foot in contact with the floor without abnormal symptomatic pressure areas, free of any significant deformity requiring surgical management. A satisfactory result was obtained in 106 (76%) and unsatisfactory result in 33 feet (24%). When separating the patients into those younger than 8 years and those older than 8 years, 67% of the patients younger than 8 years had a satisfactory result, and 82% older than 8 years had a satisfactory result. No significant complications were encountered. Because the surgery is located at the apex of the deformity in frontal, lateral, and plantar planes at the confluence of the longitudinal and transverse arches, multiplanar surgical correction was obtained in all cases at the time of the initial surgery. Currently, the most common causes of cavus deformity seen in our series were the sequelae of idiopathic talipes equinus varus clubfoot, congenital metatarsus varus, and assorted neuromuscular disorders, including Charcot-Marie-Tooth disease, cerebral palsy, and arthrogryposis.

CONCLUSIONS: On the basis of this review, the Akron dome midfoot osteotomy is a very valuable salvage procedure in the management of the rigid cavus deformity in children.

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