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Cavovarus deformities in children and adolescents require sound considerations concerning the timing for corrective surgery. Progression can be recognized best by repeated pedographic examination with evaluation of the typical features of cavovarus deformity. Surgical correction consists of a combination of soft tissue release, bony realignment, and restoration of muscle balance. In most cases plantar or medioplantar soft tissue release should be considered, whereas calf muscle lengthening is rarely indicated. Typical joint-sparing bone procedures are elevating osteotomies at the medial tarsometatarsal ray and realigning calcaneal osteotomies. Advanced cases require navicular-cuneiforme arthrodesis for correction of severe cavus component, hindfoot fusion at the Chopart line, or Lambrinudi triple fusion. Supramalleolar rotational osteotomy should be considered in severe cases. Peroneal dysfunction is addressed by peroneus longus to brevis transfer, posterior tibial tendon transfer compensates for severe extensor weakness to a certain degree, claw toes can be rebalanced by flexor or extensor tendon transfer, often in combination with proximal interphalangeal joint fusion. Surgical treatment should take into account the components of deformity, muscular function, progression and the underlying disease of the individual case. Further deterioration can be prevented by adequate surgery in the young patient. However, repeated surgical interventions may be necessary later in this patient group.

A case is reported in which a patient with Charcot-Marie-Tooth-Hoffmann disease (HMSN I) complained about bilateral ankle pain, stiffness and swelling. Radiologically multiple loose bodies in both ankle joints were detectable. The etiology of loose bodies or secondary chondromatosis is still unclear. Different reasons are discussed. Regarding the case reported on here we discuss possible etiological connections and pathophysiological pathways that may explain influence of Charcot-Marie-Tooth-Hoffmann disease (hereditary motor sensory neuropathy I) on the development of loose bodies at both ankle joints.

The deformity with which this neurological condition first shows itself is the pes cavus. During the period of growth a severely instable cavovarus deformity develops. The author avoids operations on children because the results are usually poor; the basic problem cannot be resolved with surgical measures. He recommends that the affected feet be immobilized by plastic boots until puberty is reached, at which time only minor bone resections for correcting the form of the feet are necessary. In cases of severe cavovarus deformity in early adulthood the author does not use the usual treatment, triple arthrodesis, but operates according to a technique developed by himself: a wedge osteotomy of the Chopart joints is performed to the degree necessary to permit an exact correction of the deformity. In cases of pronounced deformities, the wedge must include the entire navicular bone. After the resection the heel automatically assumes a neutral position and subtalar stability is achieved. In a number of cases the Achilles tendon must be lengthened after wedge resection. To make possible dorsal extension of the operated foot it is necessary to translocate the tendon of tibialis anterior to the base of metatarsus V. If the tibialis anterior muscle is weak or paralysed, we translocate the tendon of tibialis posterior. Instead of running this tendon through the interosseous route, we lead it subcutaneously to the distal part of the forefoot. Preoperative toe deformities are much less pronounced following the operation, and only in rare cases is correction of the first toe necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

An increasingly severe hollow foot deformity is typical of Friedreich's hereditary ataxia and Charcot-Marie-Tooth's progressive muscular atrophy. However, on the basis of personal observations it has been found that in infancy, patients with either of these diseases may have an extreme pes valgoplanus. The retrospective analysis presented here is intended to draw attention to this possibility and to point out that these diseases should also be taken into consideration in the differential diagnosis of the cause of a pes valgoplanus.