Abstract
Purpose: Anterior tarsectomy (Méary procedure) has proven its efficacy for surgery of talipes cavus in adults. There has not however been any publication on long-term outcome. We reviewed 39 cases of pes cavus treated by tarsectomy and followed for a mean ten years. Our objective was to confirm long-term results and assess consequences on adjacent joints.
Material and methods: Mean age of the patients was 30 years. Neurological causes predominated (57.6%). Most of the deformations were complex, involving equin and varus deformation of the hindfoot, and pronation and adduction of the forefoot. The deformations were painful in 85% of the patients We used the AOFAS functional score to assess outcome. The preoperative x-rays demonstrated a Djian angle at 100° and a Tomeno angle at 23°.
Results: Mean final score was 69.2/100. The final result was considered excellent or good in 66% of the patients. Pain regressed considerably in 75% of the patients even though only 28% of the patients were totally symptom free. There was a spontaneous 6° reduction in the calcaneus inclination. Defective correction persisted in 80% of the patients but the Tomeno angle remained below 10° in 70%. Seventy-four percent of the feet had radiographic signs of degenerative joints, particularly the sub-talar and mediotarsal joints.
Discussion: There were only two preoperative criteria with prognostic value, aetiology which influenced the functional result and freedom of the hindfoot articulation which determined capacity for correction. Alignment, particularly hindfoot alignment, and degenerative joint disease influenced the functional outcome.
There was a correlation between the anatomic presentation and function, especially evident for the Méary-Tomeno line which must be re-established. While we obtained spontaneous correction of the compensating frontal and sagittal deformations of the hindfoot, specific procedures were required to alleviate claw toes and equinism. It is also important to preserve the Lisfranc space and the Chopart space. The corrective capacity of tarsectomy is limited. To achieve satisfactory anatomic and functional results, tarsectomy must be reserved for moderate pes cavus involving a sufficiently mobile forefoot with moderate and reducible calcaneal varus where the primordial joints can be saved.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
