{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:12:08Z","timestamp":1788862328703,"version":"build-2803163510"},"reference-count":28,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Fixed cavovarus foot deformity is characterised by a plantar-flexed first ray, hindfoot varus, and abnormal plantar loading, often resulting in pain, instability, and gait dysfunction. The surgical correction we performed involved a deformity-driven approach to address the structural apex and associated components. Evidence linking this multilevel correction strategy to objective biomechanical improvement remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective case series evaluated outcomes following a uniform deformity-driven multilevel surgical correction protocol for fixed cavovarus deformity consisting of combined Cole midfoot osteotomy, Dwyer calcaneal osteotomy, and open Achilles tendon lengthening performed in all cases. Thirty-two relatively young skeletally mature patients (37\u2009feet), predominantly with neuromuscular etiology, were included and followed for a minimum of 18\u2009months. Primary outcome measures were patient-reported functional outcomes assessed using the Foot and Ankle Ability Measure Activities of Daily Living subscale (FAAM-ADL), radiologic alignment parameters on standardised weight-bearing radiographs, and objective gait and plantar pressure metrics. Secondary outcomes included postoperative complications. The Foot and Ankle Disability Index (FADI) was analysed as a secondary patient-reported outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      FAAM-ADL scores improved significantly from a preoperative mean of 45.2 to 77.2 at 18\u2009months (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). All radiologic parameters demonstrated significant correction, including Meary angle, calcaneal pitch angle, lateral talocalcaneal angle, anteroposterior talometatarsal angle, and talonavicular coverage angle (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). Gait analysis demonstrated a significant increase in comfortable walking speed (1.0 to 1.4\u2009m\/s,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001) and redistribution of plantar loading, with reduced lateral column pressures and increased midfoot contact area (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). The secondary FADI score also improved significantly over time (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). Complications included transient postoperative pain during the first 12\u2009months, 1 superficial wound infection, and 1 case of deformity recurrence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In this prospective case series, deformity-driven multilevel surgical correction for fixed cavovarus deformity with a midfoot apex was associated with significant improvements in patient-reported function, radiologic alignment, and objective biomechanical parameters. These findings support the role of apex-targeted multilevel correction in appropriately selected patients with rigid midfoot-driven cavovarus deformity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10711007261440930","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:48:21Z","timestamp":1779194901000},"page":"895-905","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Functional, Radiological, and Biomechanical Outcomes Following Deformity-Driven Multilevel Surgical Correction for Fixed Cavovarus Foot Deformity"],"prefix":"10.1177","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1574-4516","authenticated-orcid":false,"given":"Amr Ashraf","family":"Shouman","sequence":"first","affiliation":[{"name":"Ain Shams University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman Ebrahim Fathy","family":"Hewaidy","sequence":"additional","affiliation":[{"name":"Ain Shams University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7849-3827","authenticated-orcid":false,"given":"Mohamed Mokhtar","family":"Abd-Ella","sequence":"additional","affiliation":[{"name":"Ain Shams University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr Farouk","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Ain Shams University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9606-775X","authenticated-orcid":false,"given":"Awab Ali","family":"Mousa","sequence":"additional","affiliation":[{"name":"Ain Shams University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0536-2601","authenticated-orcid":false,"given":"Amr Mohammed","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Ain Shams University, Cairo, Egypt"},{"name":"University Hospital Lewisham, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.14193\/jkfas.2016.20.2.55"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2013.10.008"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/10711007211055460"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/1749-799X-9-44"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpm.2020.12.012"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.7547\/0950042"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2023.02.013"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fastrc.2024.100421"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/jns.12437"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.2.160077"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5413.53459"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2024.08.003"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2009.03.013"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.foot.2005.03.003"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaitpost.2008.03.011"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2005.03.006"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.7547\/17-056"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpm.2025.07.003"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110070502601113"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-014-3480-9"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/1938640018803747"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpm.2021.03.004"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpm.2025.07.005"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.24772"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpm.2021.02.004"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/10711007241242779"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/2473011421S00047"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100719882723"}],"container-title":["Foot &amp; 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