Talar Neck Osteotomy for Treating Neurologic Cavovarus Foot in an Adult: A Case Report

Talar neck osteotomy (TNO) has been reported as one of the surgical options for cavovarus foot caused by residual congenital clubfoot and neurologic disease in children, or talar neck fracture. However, TNO is rarely reported to correct the neurologic cavovarus foot in adults. We present the case of a 29-year-old male with spina bifida who exhibited a flexible cavovarus deformity of the foot, associated pain during ambulation, and plantar callosities. Preoperative weight-bearing foot radiographs showed cavovarus alignment, and three-dimensional computed tomography demonstrated increased varus/plantarflexion of the talar neck. We performed joint-preserving reconstruction comprising TNO, anterolateral transfer of the tibialis posterior tendon, dorsiflexion of the first‑metatarsal osteotomy, and Achilles tendon lengthening. At 24 months, radiographs and clinical examination confirmed a reduction of cavovarus deformity and plantar callosities. Bony union was achieved at all osteotomy sites without signs of talar avascular necrosis. The Japanese Society for Surgery of the Foot hindfoot score improved from 55 to 90, the visual analog scale for pain also improved from 7 to 0, and the‑Self-Administered Foot Evaluation Questionnaire scores improved in all domains. TNO combined with tendon transfer and first‑ray and gastrosoleus procedures can be a useful option within a comprehensive, deformity-specific strategy for adult neurologic cavovarus feet.