Foot deformity in senso-motoric polyneuropathy – often problem in orthopaedic practice. Diagnosis and choice of surgical methods

Sensory and motor polyneuropathy, and especially its demyelination type I, hypertrophic is one of the most frequent genetically conditioned neuro-muscular diseases. The aim of this study is to present a typical image of the feet in polyneuropathy and to discuss the possibility of surgical treatment. The most frequent clinical image is a hollow foot or varus and hollow foot. The toes are clawed. Regular symptoms in medical interview with the patient are: pain, muscle weakness and deformation of feet. The pathophysiology of deformation is best explained by the theory of lack of balance between the muscles: the long fibular muscle is relatively stronger than the dorsiflexor and analogically the tibialis posterior is stronger than the short fibular muscle. This theory explains the occurring plantar flexion of the first ray due to an out of proportion strong long peroneal muscle, what consequently leads to a hollow. The weakening of the dorsiflexor hinders active dorsiflexion of the foot; the patient partially compensates this with the long extensor muscle of toes. Gradually, the deformation of the feet takes place – initially dynamically, then with time it becomes permanent. Indications for treatment are the following: deformation of foot resulting from disturbed mechanics/ muscle balance with the accompanying pain due to created calluses, frequent ankle twists, problems with selecting the footwear. We presented different surgical techniques: elongation and replacement of sinews, liberation of soft tissues, osteotomies, arthrodesis. Most techniques have defined indications for application, and there is no one ‘gold standard’ proper for each deformation. The base of the success is then proper treatment planning on the basis of clinical examination and image tests. To sum up: significant and/or increasing neurogenic deformations of the feet in the process of polyneuropathy should be surgically treated, and the range of the surgery should be adjusted individually to the existing deformation.