Adductor spasticity in children with cerebral palsy (CP) impairs motor function and development. In a placebo‐controlled, double‐blind, randomized multicentre study, we evaluated the effects of botulinum toxin A(BTX‐A) in 61 children (37 males, 24 females; mean age 6 years 1 month [SD 3y 1mo]) with CP (leg‐dominated tetraparesis, n=39; tetraparesis, n=22; GMFCS level I, n=3; II, n=6; III, n=17; IV, n=29; V, n=6). Four weeks after treatment, a significant superiority of BTX‐A was observed in the primary outcome measure (knee‐knee distance ‘fast catch’, p=0.002), the Ash worth scale (p=0.001), and the Goal Attainment Scale (p=0.037).

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Detailed foot kinematics after total ankle replacement has not yet been investigated. In this study 11 patients with unilateral Hintegra ankle prosthesis were analysed with the Heidelberg Foot Model. This model measures the kinematics of the fore-, mid- and hindfoot in three clinical planes. Moreover, the kinetics of the hip, knee and ankle was captured. A diminished ROM was found in all foot segments investigated. The timing of the kinematics between sound and involved side appeared similar. A limitation in the hindfoot mobility, as experienced after ankle arthrodesis, was not observed. However, a careful hindfoot alignment is essential for optimal foot function, and previous malalignments should be corrected. Concerning the kinetics, the replaced ankle showed a decreased power generation compensated by an increase in power in the ipsilateral knee. For a more detailed evaluation, further studies are required which include pre- and postoperative data and also take into account different types of prostheses.

In pediatric flat foot a differentiation has to be made between the flexible and the rigid form. The diagnosis is based on the history, clinical examination as well as pedobarography, gait analysis and imaging techniques. It is important to rule out neuropediatric conditions such as muscular dystrophies, Ehlers-Danlos- or Marfan syndrome. In children six years of age and younger a flexible flat foot is nearly always physiological (97% of all 19 months old children). Up to the age of ten years the medial column of the foot is developing. Only a minority of children (4% in ten year olds) has a persistent or progressive deformity. Beyond to age of ten there is a danger of deformity decompensation as well as an increased rigidity. Only a minority of children develops some pain (< 2%). A clear risk factor for persistent pediatric flat foot is obesity (62% of six year old children with flat foot are obese). Pathogenetic factors include muscular, bony or soft tissue conditions. However, there specific rule is still unclear. Prevention consists in a thorough parent information about the normal development as well as encouragement of regular sportive activities. Soft and large enough shoes should be carried as a protection. Barfoot walking has to be encouraged on uneven grounds. If physiotherapy is needed different methods can be applied. Orthosis treatment should include a proprioceptive approach. Surgical interventions in children are rare. If surgical treatment is planned a detailed algorhythm should be used before utilizing one of the many different surgical methods.

ZusammenfassungOperationsziel Besserung der Funktion des in Streckstellung steifen Ellenbogengelenks als Voraussetzung einer Verbesserung der Handfunktion zur gr/Sgeren Selbst~ndigkeit im Alltags-und Berufsleben.