Functional results and quality of life after joint preserving or sacrificing surgery in Charcot-Marie-Tooth foot deformities

Abstract

Introduction

The purpose of this study was to assess the functional results, quality of life, and complications in two groups of Charcot-Marie-Tooth (CMT) patients according to the type of surgical operations, joint preserving, or joint sacrificing surgery.

Methods

Fifty-two feet in forty-six patients with CMT who had undergone surgical deformity correction were divided into two groups based on the main surgical procedure for the correction: Class I (joint preserving surgery) and class II (joint sacrificing surgery). Foot ankle disability index (FADI) and short form 12 version 2 (SF12V2) were documented pre-operative and 12 months post-operative. The complications of both groups were monitored with a mean follow-up time of 20.5 months (range, 13–71.5).

Results

After surgical treatment, FADI scores showed differences (p=0.005) between both groups. The functional improvement was 29 (20–46; p<0.001) in class I and 10 (2–36; p=0.001) in class II. The patients in both groups acquired a better quality of life as demonstrated in physical component summary of SF12 but without statistically difference. Three feet needed reintervention in class I (two for cavovarus recurrence and one for hallux flexus) at the end of follow-up. In contrast, five feet needed a new operation for cavovarus recurrence, claw toes recurrence, and ankle osteoarthritis after the progression of the condition.

Discussion

An early surgical intervention to neutralize the deforming forces in CMT patients could be a useful strategy to delay or prevent the need for extensive reconstruction and potential future complications.

Conclusion

Based on the type of surgical intervention in CMT patients, the joint preserving surgery in addition to soft tissue balancing procedures obtained better functional outcomes and lower rate of complications when compared to the group of joint sacrificing surgery.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Data Availability

Not applicable

References

  1. 1.

    Barreto LC, Oliveira FS, Nunes PS et al (2016) Epidemiologic study of Charcot-Marie-Tooth disease: a systematic review. Neuroepidemiology 46:157–165. https://doi.org/10.1159/000443706

    Article  PubMed  Google Scholar 

  2. 2.

    Ismailov S, Fedotov V, Dadali E et al (2001) A new locus for autosomal dominant Charcot-Marie-Tooth disease type 2 (CMT2F) maps to chromosome 7q11-q21. Eur J Hum Genet 9:646–650

    CAS  Article  Google Scholar 

  3. 3.

    Barton T, Winson I (2013) Joint sparing correction of cavovarus feet in Charcot-Marie-Tooth disease. What are the limits? Foot Ankle Clin 18:673–688. https://doi.org/10.1016/j.fcl.2013.08.008

    Article  PubMed  Google Scholar 

  4. 4.

    Coleman SS, Chesnut WJ (1977) A simple test for hindfoot flexibility in the cavovarus foot. Clin Orthop 123:60–62

    Google Scholar 

  5. 5.

    Laurá M, Singh D, Ramdharry G et al (2018) Prevalence and orthopedic management of foot and ankle deformities in Charcot-Marie-Tooth disease. Muscle Nerve 57:255–259. https://doi.org/10.1002/mus.25724

    Article  PubMed  Google Scholar 

  6. 6.

    Levitt RL, Canale ST, Cooke AJ Jr, Gartland JJ (1973) The role of foot surgery in progressive neuromuscular disorders in children. J Bone Joint Surg Am 55:1396–1410

    CAS  Article  Google Scholar 

  7. 7.

    Mann DC, Hsu JD (1992) Triple arthrodesis in the treatment of fixed cavovarus foot deformity in adolescent patients with Charcot-Marie-Tooth disease. Foot Ankle 13:1–6. https://doi.org/10.1177/107110079201300101

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Breusch SJ, Wenz W, Döderlein L (2000) Function after correction of a clawed great toe by a modified Robert Jones transfer. J Bone Joint Surg Br 82:250–254. https://doi.org/10.1302/0301-620x.82b210276

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Leeuwesteijn AE, de Visser E, Louwerens JW (2010) Flexible cavovarus feet in Charcot-Marie-Tooth disease treated with first ray proximal dorsiflexion osteotomy combined with soft tissue surgery: a short-term to mid-term outcome study. Foot Ankle Surg 16:142–147. https://doi.org/10.1016/j.fas.2009.10.002

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    McCluskey WP, Lovell WW, Cummings RJ (1989) The cavovarus foot deformity. Etiol Manag. Clin Orthop Relat Res 247:27–37

    Google Scholar 

  11. 11.

    Martin RL, Burdett RG, Irrgang JJ (1999) Development of the foot and ankle disability index (FADI). J Orthop Sports Phys Ther 29:32–33

    Google Scholar 

  12. 12.

    Mani SB, Do H, Vulcano E et al (2015) Evaluation of the foot and ankle outcome score in patients with osteoarthritis of the ankle. JBJS 97:662–667. https://doi.org/10.1302/0301-620X.97B5.33940

    Article  Google Scholar 

  13. 13.

    Ware J Jr, Kosinski M, Keller SDA (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233. https://doi.org/10.1097/00005650-199603000-00003

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Vinci P, Esposito C, Perelli SL, Antenor JAV, Thomas FP (2003) Overwork weakness in Charcot-Marie-Tooth disease. Arch Phys Med Rehabil 84:825–827. https://doi.org/10.1016/S0003-9993(02)04949-3

    Article  PubMed  Google Scholar 

  15. 15.

    Faldini C, Traina F, Nanni M, Mazzotti A, Calamelli C, Fabbri D, Pungetti C, Giannini SJJ (2015) Surgical treatment of cavus foot in Charcot-Marie-tooth disease: a review of twenty-four cases. J Bone Joint Surg Am 97:1–10. https://doi.org/10.2106/JBJS.N.00794

    Article  Google Scholar 

  16. 16.

    Dreher T, Beckmann NA, Wenz (2015) Surgical treatment of severe cavovarus foot deformity in Charcot-Marie-tooth disease. JBJS Essent Surg Tech 5:11. https://doi.org/10.2106/JBJS.ST.N.00005

    Article  Google Scholar 

  17. 17.

    Selber R, Filho ER, Dallalana R et al (2004) Supramalleolar derotation ostetotomy of the tibia with plate fixation. J Bone Joint Surg Br 86(8):1170–1175. https://doi.org/10.1302/0301-620x.86b8.14479

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    McNicol D, Leong JCY, Hsu LCS (1983) Supramalleolar derotation osteotomy for lateral tibial torsion and associated equinovarus deformity of the foot. J Bone Jt Surg-Ser B 65:166–170. https://doi.org/10.1302/0301-620x.65b26826623

    CAS  Article  Google Scholar 

  19. 19.

    Bosman HA, Robinson AHJF (2013) Treatment of ankle instability with an associated cavus deformity. Foot Ankle Clin 18:643–657. https://doi.org/10.1016/j.fcl.2013.08.005

    Article  PubMed  Google Scholar 

  20. 20.

    Simon A-L, Seringe R, Badina A, Khouri N, Glorion C, Wicart PJF (2019) Long term results of the revisited Meary closing wedge tarsectomy for the treatment of the fixed cavo-varus foot in adolescent with Charcot-Marie-Tooth disease. Foot Ankle Surg 25:834–841. https://doi.org/10.1016/j.fas.2018.11.005

    Article  PubMed  Google Scholar 

  21. 21.

    Zide JR, Myerson MS (2013) Arthrodesis for the cavus foot when, where, and how? Foot Ankle Clin N Am 18:755–767. https://doi.org/10.1016/j.fcl.2013.08.012

    Article  Google Scholar 

  22. 22.

    Wetmore RS, Drennan JC (1989) Long-term results of triple arthrodesis in Charcot-Marie-Tooth disease. J Bone Joint Surg Am 71:417–422

    CAS  Article  Google Scholar 

  23. 23.

    Maynou C, Szymanski C, Thiounn A (2017) The adult cavus foot. EFORT Open Reviews 2017 2:5, 221-229. https://doi.org/10.1302/2058-5241.2.160077

  24. 24.

    Ward CM, Dolan LA, Bennet DL, Morcuende JA, Cooper RR (2008) Long-term results of reconstruction for treatment of a flexible cavovarus foot in Charcot-Marie-Tooth disease. J Bone Joint Surg Am 90:2631–2642. https://doi.org/10.2106/JBJS.G.01356

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Pfeffer GB, Michalski M, Nelson T, An TW, Metzger MJF (2020) Extensor tendon transfers for treatment of foot drop in Charcot-Marie-Tooth disease: a biomechanical evaluation. Foot Ankle Int 41:449–456. https://doi.org/10.1177/1071100719901119

    Article  PubMed  Google Scholar 

  26. 26.

    Guyton GP (2006) Current concepts review: orthopaedic aspects of Charcot-Marie-Tooth disease. Foot Ankle Int 27:1003–1010. https://doi.org/10.1177/107110070602701125

    Article  PubMed  Google Scholar 

  27. 27.

    Sivera R, Sevilla T, Vílchez JJ, Martinez-Rubio D, Chumillas MJ, Vazquez JF et al (2013) Charcot-Marie-Tooth disease: genetic and clinical spectrum in a spanish clinical series. Neurology 81:1617–1625. https://doi.org/10.1212/WNL.0b013e3182a9f56a

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Louwerens JWK (2018) Operative treatment algorithm for foot deformities in Charcot-Marie-Tooth. Oper Orthop Traumatol 30:130–146. https://doi.org/10.1007/s00064-018-0533-0

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Pfeffer GB, Gonzalez T, Brodsky J et al (2020) A consensus statement on the surgical treatment of Charcot-Marie-Tooth disease. Foot Ankle Int 41:870–880. https://doi.org/10.1177/1071100720922220

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the participation of Eloisa Rubio Pérez (Statistics and Research Methodology Unit) for her help with methods and statistical analysis.

Code availability

Not applicable

Author information

Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Sergio Tejero. The first draft of the manuscript was written by Sergio Tejero, and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

• Conceptualization: Sergio Tejero and Mario Herrera-Pérez

• Methodology: Sergio Tejero and Juan Chans-Veres

• Formal analysis and investigation: Sergio Tejero and Andrés Carranza-Bencano

• Writing - original draft preparation: Sergio Tejero

• Writing - review and editing: Ahmed Galoum, Daniel Poggio, and Victor Valderrabano

• Funding acquisition: Not applicable

• Resources: Not applicable

• Supervision: Ahmed Galoum, Daniel Poggio, and Victor Valderrabano

• Validation: Sergio Tejero and Juan Chans-Veres

• Visualization: Sergio Tejero, Juan Chans-Veres and Mario Herrera-Pérez.

Corresponding author

Correspondence to Sergio Tejero.

Ethics declarations

Ethics approval

Ethical approval for this study was obtained from our institution’s ethical review committee (CEIC 1925-N-19).

Consent to participate

The authors affirm that all individuals consented to participate in this study.

Consent for publication

The authors affirm that participants provided informed consent for the publication of their data and photographs.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Level of evidence: Level IV, case series

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tejero, S., Chans-Veres, J., Carranza-Bencano, A. et al. Functional results and quality of life after joint preserving or sacrificing surgery in Charcot-Marie-Tooth foot deformities. International Orthopaedics (SICOT) (2021). https://doi.org/10.1007/s00264-021-04978-7

Download citation

Keywords

  • Charcot-Marie-Tooth
  • Hereditary motor sensory neuropathy
  • Tendon transfer foot ankle
  • Triplanar tarsal osteotomy