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We treated 22 children (28 limbs) with diplegic cerebral palsy who were able to walk by the Baumann procedure for correction of fixed contracture of the gastrosoleus as part of multilevel single-stage surgery to improve gait. The function of the ankle was assessed by clinical examination and gait analysis before and at two years (2.1 to 4.0) after operation. At follow-up the ankle showed an increase in dorsiflexion at initial contact, in single stance and in the swing phase. There was an increase in dorsiflexion at initial push-off without a decrease in the range of movement of the ankle, and a significant improvement in the maximum flexor moment in the ankle in the second half of single stance. There was also a change from abnormal generation of energy in mid-stance to the normal pattern of energy absorption. Positive work during push-off was significantly increased. Lengthening of the gastrocnemius fascia by the Baumann procedure improved the function of the ankle significantly, and did not result in weakening of the triceps surae. We discuss the anatomical and mechanical merits of the procedure.

We treated 22 children (28 limbs) with diplegic cerebral palsy who were able to walk by the Baumann procedure for correction of fixed contracture of the gastrosoleus as part of multilevel single-stage surgery to improve gait. The function of the ankle was assessed by clinical examination and gait analysis before and at two years (2.1 to 4.0) after operation. At follow-up the ankle showed an increase in dorsiflexion at initial contact, in single stance and in the swing phase. There was an increase in dorsiflexion at initial push-off without a decrease in the range of movement of the ankle, and a significant improvement in the maximum flexor moment in the ankle in the second half of single stance. There was also a change from abnormal generation of energy in mid-stance to the normal pattern of energy absorption. Positive work during push-off was significantly increased. Lengthening of the gastrocnemius fascia by the Baumann procedure improved the function of the ankle significantly, and did not result in weakening of the triceps surae. We discuss the anatomical and mechanical merits of the procedure. Equinus deformity is commonly encountered in children with cerebral palsy. Good function of the foot is essential for normal gait. The heel, ankle and forefoot rockers optimise the shock-absorbing, stabilising, and propulsive functions of the foot. Equinus causes a decrease in the stability of the stance phase, loss of smooth transition of the body over the foot, and inadequate clearance of the foot in the swing phase.1 Persistent deformity interfering with gait requires lengthening of the triceps surae. A wide variety of procedures has been described for the surgical correction of equinus (Table I). Few studies have used gait analysis to analyse objectively the outcome of different methods of lengthening of the triceps surae. Sharrard and Bernstein 2 presented an eightyear follow-up of 57 patients treated either by lengthening of the tendo Achillis or by aponeurotic lengthening of gastrocnemius. They found a recurrence of equinus of 15% in aponeurotic lengthening compared with 23% in lengthening of the tendo Achillis. Their study did not include analysis of gait. Perry et al 3 reported a study of the function of triceps surae before and after surgery, using electromyography and clinical analysis of gait. They found simultaneous activity in the gastrocnemius and soleus to the quick stretch test, and suggested that the Silfverskiöld test, although unreliable in the conscious patient, can give consistent results when carried out under anaesthesia. Yngve and Chambers 4 compared ankle function after Vulpius lengthening of the gastrocnemius fascia for gastrocnemius contracture with Z-lengthening of tendo Achillis for contracture of the gastrosoleus. They found an equal improvement in the ankle moments and in push-off one year after surgery in both groups. Entyre et al 5 studied changes in ankle function after the Vulpius procedure and Z-lengthening using electromyography and ankle kinematics. They found no difference in th...

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Multilevel surgery for gait improvement was performed on 29 ambulatory children with diplegic cerebral palsy. Patients were divided into two groups based on the presence of dynamic equinus (12 cases) and fixed equinus deformity (17 cases). Dynamic equinus deformities were not corrected surgically, and fixed deformities were corrected by intramuscular gastrosoleus lengthening. Ankle function was evaluated by clinical examination and gait analysis before surgery and a minimum of 3 years after surgery. Positive changes in ankle function were observed in both the groups. Conservative management of dynamic equinus deformities resulted in significant improvements in ankle function. Intramuscular lengthening of fixed equinus deformities does not cause a weakening of the muscle and improves static and dynamic function of the ankle.