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J Foot Ankle Surg. 2009 Nov-Dec;48(6):637-41. doi: 10.1053/j.jfas.2009.07.009. Epub 2009 Sep 10.

A modified Jones procedure for managing clawing of lesser toes in pes cavus: long-term follow-up in 8 patients.

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  • 1Clinical Fellow Orthopaedics, Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland.


Pes cavus is a complex foot deformity in which surgical correction remains challenging. We treated lesser-toe clawing in 11 feet of 8 patients (5 women, 1 bilateral; 3 men, 2 bilateral) with a modified Jones procedure and assessed long-term functional outcomes. We reviewed case notes and completed the Bristol Foot Score, the modified American Orthopaedic Foot & Ankle Society Midfoot Score, and a patient satisfaction questionnaire by means of telephone interviews. Mean age of the patients at the time of surgery was 30 years (range, 10-58 years). Mean time from surgery to the last clinical follow-up was 7 years (range, 0.5-17 years), and mean time from surgery to the telephone interview was 9 years (range, 1-18 years). At the final clinical review, all 11 feet were improved, although 6 had minor complications. The mean Bristol Foot Score was 27 (range, 16-55), and the mean modified American Orthopaedic Foot & Ankle Society Midfoot Score was 76 (range, 47-90), indicative of excellent results. Half of the patients had mild persistent foot pain, but all were satisfied with the outcome. Based on our experience with this group of patients, the modified Jones procedure yields satisfactory correction of lesser toe clawing in patients with flexible pes cavus.



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