Clinical determination of forefoot morphotypes in flexible Charcot-Marie-Tooth cavovarus feet - A novel system of clinical examination.

BACKGROUND: Cavovarus foot morphology varies significantly, necessitating bespoke treatment. Four distinct forefoot morphotypes have been described which may aid surgical planning. This study assesses whether clinical examination can accurately assess forefoot morphotype. METHODS: Retrospective, single-centre study including 60 CMT cavovarus feet. Feet were categorised clinically into four previously described morphotypes by two clinicians. Clinical findings were compared to software-based categorisation of weightbearing CT images (30 feet). RESULTS: Inter-rater reliability was 0.943 for clinical versus software; 0.938 between clinicians. 60% were Type 1, 21.7% Type 2, 10% Type 3 and 8.3% Type 0. Three distinct subtypes of Type 3 were noted: Balanced (pure adduction), Plantarflexed (additional plantarflexion of first ray) and Pronated (additional pronation of whole forefoot). Eleven Type 1/2 feet had an Adduction subtype. CONCLUSION: Cavovarus foot morphology can be reliably identified on clinical examination. This may aid decision making for surgeons without access to weightbearing CT or specialised software.