Description of patient (type of occupation, indication of age, intensity of sport):
A 28-year-old female with Charcot Mary Tooth disease
History and previous treatment:
2008 Cavus left foot with fatigue fracture of the 5th metatarsal bone
2010 Left foot: Wedge tarsectomy + Lateral Calc slide
2015 Early recurrence of the deformity lead to Chopart joint fusion of the left foot
2017 Chopart joint fusion of the right foot
Left ankle: anterior ankle pain (superficial & deep). Slight recurrence of the equines deformity requiring orthotic soles with a 1 cm heel rise. Catching of the ankle. Unlimited walking distance but with pain occuring after 1 to 2 km.
Lack of dorsiflexion. Reproducible superficial anterolateral ankle pain with dorsiflexion. Catching of the ankle. Slight deficit on Peroneus brevis and anterior tibial muscle testing: 4 on a 0 to 5 scale.
[Picture 1 + 2]: X-ray shows an aligned foot and flat top talus with OCD and anterior kissing lesion.
Talus OCD on CMT patient 4 years after a double hindfoot fusion.
Question(s) to this case:
Removal of the osteophytes was propose to the patient. What would you recommend with the OCD?
Difficult case. The (antero-)lateral cyst is the result of an insufficiency infraction caused by repetitive forcing dorsiflexion because of the limited dorsiflexion.
Removal of osteofytes will result in progression of this process and collapse of the cyst. The current osteofytes protect the talus from further collaps. Best would be to not touch and to treat conservative. If surgery needs to be done I would perform LDFF (Lift Drill Fill Fix) and limited removal of osteofytes (only partial removal of osteofyte).