Page 5 - 2020 Spring CMTA Report

Figure 2: Figure 3: Figure 4:
THE PERONEUS LONGUS THE PERONEUS BREVIS TOE EXTENSOR TENDONS

the inside of the arch and helps to avoid braces or who has feet upward from over-pull of the
support it, much like a cable on that are not sitting flat within tendon, and foot drop is mini-
a suspension bridge. Its pull is braces. At the same surgery, if the mized. Although not commonly
normally balanced out by the pull peroneus longus is also strong done in the United States, I find
of the peroneus brevis tendon, enough (which is usually the case), that this transfer is often the key
which inserts on the opposite side it is transferred to the outside of to a successful surgery. I am very
of the middle of the foot. These the foot into the peroneus brevis. proud that Max Michalski, MD,
two tendons are what allow the This is done by sewing my previous resi-
foot to move side to side and stay the tendons together. dent, and our
flat on the ground when walking. This transfer takes The longer CMT team at
In a CMT patient, the posterior away the deforming the muscle Cedars-Sinai
tibial stays strong compared to force of the peroneus imbalance is recently won a
the peroneus brevis and causes longus that is pulling in place, national first place
the progressive inward turn of the down the inside of the prize for our pub-
foot. That’s why many of you can foot and creates a sta- the worse the lished research on
turn your foot inward much better bilizing force to deformity this technique.
than you can turn it outward. prevent the foot from becomes and The longer the
The most important part of CMT twisting inward. CMT the harder it is muscle imbalance
cavovarus surgery is the balancing surgery is all about to correct is in place, the
of these tendons, both to improve taking away the strong worse the defor-
function and to minimize the use tendons that are with surgery. mity becomes
of braces. deforming the foot Big problems and the harder it
If the posterior tibial tendon and transferring them start small. is to correct with
functions, it can be transferred to strengthen the surgery. Big prob-
from the leg to the top of the foot. weaker tendons. lems start small.
This accomplishes two important A final key transfer has to Even if your CMT progresses, it is
things. First, it takes away the do with the toe extensor tendons important to balance the foot and
deforming force of the muscle that that run down the top of the foot minimize further deformity. Please
twists the foot inward. Second, it (Figure #4). If sufficiently strong, see an orthopedic foot and ankle
provides strength for the ankle to I frequently transfer these tendons specialist early. h
move up. This can make all the into the midfoot, at the top of the In Part 3 we will discuss
difference to someone who wants arch. The toes no longer deform the role of fusions.

SPRING 2020 THE CMTA REPORT 5