Introduction A successful adjusted treatment algorithm for the correction of cavovarus foot deformity requires soft-tissue balancing procedures, in particular total split posterior tibial tendon transfer (T-SPOTT), in combination with adjunctive corrective procedures depending on the degree of deformity.
Step 1: Surgical Preparation Place the patient in a supine position and follow a standard aseptic surgical disinfection and draping protocol, allowing access to the iliac crest.
Step 2: Steindler Release of the Plantar Aponeurosis Use a medial approach to access and transect the plantar aponeurosis.
Step 3: Release the Posterior Tibial Tendon at the Foot Transect the posterior tibial tendon near its insertion point.
Step 4: Retract and Split the Posterior Tibial Tendon at the Calf and Transfer It Through the Interosseous Membrane Make a medial incision in the distal part of the calf, retract the posterior tibial tendon (and flexor digitorum tendon if necessary), split it longitudinally in half, and pass it through the interosseous space.
Step 5: Reveal the Target Tendons and Pull the Posterior-Tibial-Tendon Halves to These Tendons Expose the anterior tibial and peroneal tendons and pull the posterior-tibial-tendon halves (and flexor digitorum longus tendon of it is being used) to these tendons.
Step 6: Chopart, or Triple or Lambrinudi, Arthrodesis Perform a Chopart, or triple or Lambrinudi16, arthrodesis when osseous correction and stabilization are required for fixed deformities.
Step 7: Modified Jones Procedure If the cavovarus foot displays flexible clawing of the big toe, carry out a modified Jones procedure.
Step 8: Extension Osteotomy of the First Metatarsal If the first metatarsal remains in a fixed plantar flexed position and cannot be corrected with the Jones procedure, perform a dorsal-based wedge extension osteotomy.
Step 9: Clawing of the Lesser Toes Incise the plantar tendons, transect the long flexor tendons, and place a single Hohmann wire …
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