I begin to write this post, after having a forty-five minute video-consultation with a patient from Australia, who lives in Brisbane, in the east of the continent. She has unsightly cavus varus feet, by Charcot-Marie-Tooth. Like so many patients in many parts of the world who suffer from Charcot-Marie-Tooth disease, they reject the treatments that many hospitals want to give them. The fixation of the ankle, extended to the medial column of the foot and the operation of Jones that fixes the big toe when they are in claw, are the techniques without principles with which they wanted to treat it. Now she wants to come to Spain, to reconstruct her feet and abandon the orthoses she now uses and that apart from not cure the problem, she causes sores on the outside of the ankle, as you can see in these pictures.
Again, in my opinion, mistakes are repeated in not recognizing that the problem is neuromuscular and that the bones are the ones that suffer the consequences of this. If to reconstruct a neurological foot, they forget to handle the main causes of the deformity as the muscles. This type of surgery is not only doomed to failure, but also to the worsening of the functional situation of the feet of these patients.
This is why I show you the case of this patient from Jaén, in the south of Spain, with cavus varus feet and ankle instability by Charcot-Marie-Tooth, type 1. We have operated to reconstruct her feet, as well as repairing the ankle ligaments, to make her walk back steadily and with her ankles keep moving.
She, an aeronautical engineer, started with the disease in adolescence, affecting both feet. The left more damaged than the right. Both with deformity in equinus cavus varus by paralysis of the anterior tibial and the peroneus brevis muscles. Then over the years and increased body weight, they caused repeated ankle sprains that led to the rupture of the external ligaments of the ankle. Her lack of treatment is what triggered that apart from the deformity, added serious instability of the ankle.
More than a year ago we operated on both feet at once, correcting the malalignment, giving stability to the foot and transferring tendons to the dorsum of the feet. With that we managed to keep the foot from falling when walking. But our surprise was very great when she began to walk and the ankle turned again to deviate. And this is not because the reconstruction was done wrong, but it was because of the fact that the ankle instability, could not be diagnosed due to the ankle deformity. When this was corrected, the instability of the ankle appeared. For this reason we had to take our patient back to the operating room and anatomically reconstruct the ankle external ligaments, with a patient’s own tendon graft, a knee muscle flexor. In order to repair the last sequel of Charcot-Marie-Tooth disease.
The principles of foot reconstruction with Charcot-Marie-Tooth
Especially as you can see in the video, recorded 5 months after the last operation, our engineer normally walks again with her feet stable, well aligned and with his muscles balanced and also maintain the mobility and stability of the ankle. More importantly, our daily work and effort has its reward, as we currently have patients coming from all five continents, who come to IICOP.
This is a reward for doing our work well, we obviously can not cure everyone, but this makes Charcot-Marie-Tooth patients choose our clinic to treat the orthopedic problems of this disease.