**7.3 Cavovarus**

Cavovarus foot deformity is more prevalent in patients with a sacral level spina bifida and it is present in up to 17% of the patients [41]. The deformity is the cause of foot muscle imbalance (**Figure 13**). The treatment is dependent on how flexible the hindfoot is. This must be assessed by the orthopedic surgeon with the Coleman

**101**

**Figure 11.**

**Figure 12.**

*Four-year-old patient with bilateral equinus.*

calcaneus osteotomy [42, 43].

block test. If the hindfoot is flexible, only the forefoot will need to be addressed surgically. Meanwhile on the case of a rigid hindfoot several osteotomies may be needed to achieve correction. The current recommendations with high percent of success are for a first metatarsal closing wedge, an opening plantar wedge osteotomy of the medial cuneiform, a closing wedge cuboid osteotomy and sliding

*K wires used after posterior release in a 12 months old patient with rigid bilateral clubfeet.*

*Orthopedic Approach to Spina Bifida*

*DOI: http://dx.doi.org/10.5772/intechopen.94901*

*Orthopedic Approach to Spina Bifida DOI: http://dx.doi.org/10.5772/intechopen.94901*

*Spina Bifida and Craniosynostosis - New Perspectives and Clinical Applications*

Additionally, if serial casting is being implement is paramount to assess skin integrity at every cast change in these patients due to their insensate feet. After correction is achieved by casting the treatment is followed by an Achilles tendon tenotomy, usually open in these patients [38]. If a wider soft tissue release is needed later on due to a recurrence a radical posteromedial release is recommended. In this procedure the subtalar, talonavicular and calcaneocuboid joints are completely released. After surgery casting followed by ankle foot orthosis (AFO) is required to maintain the correction. If a recurrence is then again noted, which may occur in 20–50% of the patients, a talectomy is indicated to achieve a plantigrade braceable

*Patient with a bilateral cavovarus deformity being examined in clinic with the help of a podoscope.*

This deformity is also associated with higher levels of spina bifida. If the deformity is flexible an AFO may be attempted to prevent further progressing to a rigid equinus (**Figure 11**). With increasing severity of the deformity an Achilles tendon excision is recommended and even a radical posterior release if a plantigrade foot is not achieved after the Achilles resection [40]. Once the foot is an acceptable position a K wire is used in the talocalcaneal joint to maintain the alignment while to

Cavovarus foot deformity is more prevalent in patients with a sacral level spina bifida and it is present in up to 17% of the patients [41]. The deformity is the cause of foot muscle imbalance (**Figure 13**). The treatment is dependent on how flexible the hindfoot is. This must be assessed by the orthopedic surgeon with the Coleman

foot remains in a cast for at least 6 weeks (**Figure 12**).

**100**

foot [39].

**Figure 10.**

**7.2 Equinus**

**7.3 Cavovarus**

**Figure 11.** *Four-year-old patient with bilateral equinus.*

**Figure 12.** *K wires used after posterior release in a 12 months old patient with rigid bilateral clubfeet.*

block test. If the hindfoot is flexible, only the forefoot will need to be addressed surgically. Meanwhile on the case of a rigid hindfoot several osteotomies may be needed to achieve correction. The current recommendations with high percent of success are for a first metatarsal closing wedge, an opening plantar wedge osteotomy of the medial cuneiform, a closing wedge cuboid osteotomy and sliding calcaneus osteotomy [42, 43].

## *Spina Bifida and Craniosynostosis - New Perspectives and Clinical Applications*

#### **Figure 13.**

*Myelomeningocele patient with bilateral cavovarus feet and accompanying radiographic images depicting the high medial arch and the varus deformity.*
