Pes planovalgus deformity surgical correction in ambulatory children with cerebral palsy

Abstract

Purpose Planovalgus foot deformity is common in diplegic and quadriplegic patients. Surgery is the definitive treatment to restore the alignment of the talus, calcaneus, and navicular bones. We aimed, in the current study, to compare the effectiveness of subtalar fusion and calcaneal lengthening, and to assess the recurrence in ambulatory children with cerebral palsy. Methods This is a retrospective study of 78 patients (138 feet diagnosed with planovalgus deformity) who underwent surgical correction using subtalar fusion or calcaneal lengthening. Range of motion, radiographic indices, kinematic, and pedobarographic data were used to examine the deformity and the outcome of surgery. A repeated measures analysis of variance (ANOVA) was used to test the study hypothesis. Results Most of the patients were diplegic (87.2 %) and the mean age at surgery was 11.9 ± 2.9 years (range from 4.7 to 18.3 years), with a mean follow-up of 5 ± 4.4 years (range from 1 to 15.4 years). Sixty-three feet were treated with calcaneal lengthening, while 75 were treated with subtalar fusion. The feet treated with subtalar fusion were more severe preoperatively. However, both surgery groups showed improvement postoperatively. Among 12 cases of recurrence, medial column fusion was the main surgery performed to correct the deformity.Conclusions Surgery is effective in the treatment of planovalgus deformity in ambulatory children with cerebral palsy. Severe and rigid planovalgus feet can be treated effectively with subtalar fusion. Feet with milder deformity show good results, with calcaneal lengthening. Surgery provides good correction in young patients, but there is a higher recurrence rate.

Pes planovalgus deformity in children with cerebral palsy

“…Total medial column fusion was performed for very severe deformities and provided excellent correction of severe planovalgus deformities [14]. We obtained good results, with maintenance of reduction of the planovalgus after a mean of 8 years of follow-up [15].…”

“…The benefits of mobilizing the forefoot and midfoot segments through the osteotomy site are tightening of the plantar fascia and reduction in the position of the talus over the calcaneus without damaging the joint motion. Calcaneal lengthening has been commonly used for CP children with planovalgus foot deformity with good results [10][11][12][13][14][15][16].…”

“…Intra-articular subtalar fusion has been also utilized in CP children for correction of planovalgus deformity [15,16,26]. The utilization of two screws to reduce the subtalar joint was previously described by Judet as Cavalier's Procedure, where no decortication of the articular surfaces was performed [27].…”

“…The debate on whether severe planovalgus feet can be corrected with calcaneal lengthening in children with CP [10,11] or whether this technique is applicable only for flexible and less severe planovalgus feet in good ambulators [12][13][14][15][16]34] persists; however, the exact indications are not very widely established.…”

“…Our indications for calcaneal lengthening are in GMFCS I, II, and highfunctioning GMFCS III walkers with mild-to-moderate planovalgus deformity (Fig. 1) [12,14,15]. Patients with low functional abilities and severe rigid planovalgus foot deformity are commonly managed with subtalar fusion (Fig.…”