Subtalar realignment arthrodesis in the mid-stage neurogenic cavovarus foot

Charcot Marie Tooth (CMT) disease is a progressive neuromuscular disorder that is often the underlying condition involved in the development of a symptomatic cavovarus foot. End-stage foot deformities frequently result in triple arthrodesis procedures performed later in the disease process. The main surgical goal is to achieve a stable, plantigrade foot. Ideally, treatment would avoid triple arthrodesis as this procedure increases adjacent joint demands and expedites development of resultant arthrosis. Some authors have stated that earlier intervention by tendon balancing techniques may alleviate the need for joint fusions in the future. Therefore, the timing of surgical intervention is paramount in the medical decision making process. Our case series reviews mid-stage cavovarus progression in patients with pedal instability and gait disturbances. Realignment subtalar arthrodesis is utilized to improve Kite’s angle, reduce heel varus and re-establish subtalar joint (STJ) stability.  Tendon balancing procedures should be performed in conjunction with STJ arthrodesis in order to achieve long standing correction and hopefully prevent the future need for conversion to triple arthrodesis.