Subtalar Arthrodesis in Children

Gallien, Roger; Morin, François; Marquis, François

doi:10.1097/01241398-198901000-00011

Cited by 32 publications

(20 citation statements)

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“…Results The mean lateral talo-calcaneal angle was reduced significantly (P \ 001) from 55.1°(SD ± 8.9) to 38.8°(SD ± 8.1). The mean frontal talo-calcaneal angle was reduced from 24.7°(SD ± 9.7) pre-operatively to 16.6°(SD ± 6.3) at follow-up (P \ 0.001). The mean lateral talo-first-metatarsal angle improved significantly from -16.1°(SD ± 24.7) pre-operatively to 0.9°(SD ± 15.1) at follow-up (P = 0.0015).…”

mentioning

confidence: 89%

“…The operation is found to be a demanding one, even among experienced surgeons [1,[11][12][13][14], but it is a major advantage that it does not affect further bone growth or necessitates the resection of local bone. The procedure has also been used in children with myelomeningocele [15,16], which typically has concomitant valgus instability of the ankles, and correcting the subtalar joint addresses, in many cases, only part of the problem. Adequate pre-operative radiographs of both the feet and ankles are of the essence to locate the cause of the valgus instability.…”

Section: Introductionmentioning

confidence: 99%

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Grice arthrodesis in the treatment of valgus feet in children with myelomeningocele: A 12.8-year follow-up study

Høiness¹,

Kirkhus²

2009

Journal of Children's Orthopaedics

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Purpose Neurological deficit resulting in the lack of motor control in children with myelomeningocele often leads to a valgus position of the feet and ankles, usually in combination with planovalgus and pronation of the forefoot. The purpose of the study was to evaluate long-term patient satisfaction and clinical effects in ambulating children with lumbosacral myelomeningocele after having performed a Grice arthrodesis of a valgus unstable foot. The clinically most relevant radiographic measurements, such as the frontal and lateral talo-calcaneal angles, were used to evaluate the anatomical effects of the surgery, whereas the main research question was to reveal the patient satisfaction and usefulness of the procedure. Methods The modified Grice-Green extraarticular subtalar arthrodesis was performed by the same surgeon on one standing and 22 walking patients (12 female) with lumbosacral myelomeningocele and valgus instability during the period 1985-1999. Twelve patients had bilateral surgery, giving a total of 35 operated feet. The patients attended a thorough check-up at a mean of 12.8 years (standard deviation [SD] ± 3.2, range 7.7-20.2 years) after surgery. The mean age at surgery was 6.6 years (SD ± 1.8) and at follow-up 19.4 years (SD ± 3.8). Functional parameters, such as walking ability, pain and skin problems, and the need for braces and supportive orthopaedic shoes were noted at the follow-up interview. The parents were interviewed along with the patients in order to obtain all of the necessary information. Loaded radiographs in the lateral and frontal planes were taken of both feet and ankles pre-operatively and at follow-up, except for pre-operative radiographs in six patients that were not loaded and, thus, not included, except for the assessment of ankle valgus. Ankle valgus was assessed from lateral and frontal views of the ankle on a scale from grade 0 to grade 3 according to Malhotra. Frontal and lateral talo-calcaneal angles were measured for the assessment of subtalar varus or valgus. Lateral talo-first-metatarsal (Meary's) angles were measured to investigate the longitudinal arches of the feet. Results The mean lateral talo-calcaneal angle was reduced significantly (P \ 001) from 55.1°(SD ± 8.9) to 38.8°(SD ± 8.1). The mean frontal talo-calcaneal angle was reduced from 24.7°(SD ± 9.7) pre-operatively to 16.6°(SD ± 6.3) at follow-up (P \ 0.001). The mean lateral talo-first-metatarsal angle improved significantly from -16.1°(SD ± 24.7) pre-operatively to 0.9°(SD ± 15.1) at follow-up (P = 0.0015). The calcaneal pitch did not change significantly. In general, ankle valgus worsened during follow-up time, but not significantly (P = 0.113). The visual analogue scale (VAS) score of patient satisfaction improved significantly from 3.7 (SD ± 1.7) prior to surgery to 7.2 (SD ± 1.5) at follow-up (P \ 0.005). Nineteen patients (83%) were satisfied with the surgery and would thus recommend the procedure. Conclusions Based on the radiological findings and patient satisfaction, the patients participa...

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mentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Grice arthrodesis in the treatment of valgus feet in children with myelomeningocele: A 12.8-year follow-up study

Høiness¹,

Kirkhus²

2009

Journal of Children's Orthopaedics

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“…In their series, good results were obtained in 82% of the feet, and three of the poor results were due to unrecognized concomitant distal tibia valgus deformity. Various types of arthrodesis procedures have been reported in patients with spina bifida and valgus deformity [39,40]. However, these should be avoided at all costs in this patient population with impaired sensation.…”

Section: Hindfoot Valgusmentioning

confidence: 99%

Orthopaedic management of spina bifida—part II: Foot and ankle deformities

Swaroop

Dias

2011

Journal of Children's Orthopaedics

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Both congenital and acquired orthopaedic deformities are common in patients with spina bifida. Examples of congenital deformities, which are present at birth, include clubfoot and vertical talus. Acquired developmental deformities are related to the level of neurologic involvement and include calcaneus and cavovarus. Orthopaedic deformities may also result from postoperative tethered cord syndrome. The previously published Part I reviewed the overall orthopaedic care of a patient with spina bifida, with a focused review of hip, knee, and rotational deformities. This paper will cover foot and ankle deformities associated with spina bifida, including clubfoot, equinus, vertical talus, calcaneus and calcaneovalgus, ankle and hindfoot valgus, and cavovarus. In addition, this paper will address the issues surrounding skin breakdown in patients with spina bifida.

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“…There is a correlation between the extent of shortening of the fibula and the severity of wedging of the distal tibial epiphysis leading to ankle valgus [21,25,28]. Underdevelopment of the fibula is often observed in paralyzed limbs, leading to ankle valgus [29]. In most cases, ankle valgus is present before stabilization, but tends to deteriorate after arthrodesis [1,2,14].…”

Section: Discussionmentioning

confidence: 99%

Modified Grice–Green subtalar arthrodesis performed using a partial fibular graft yields satisfactory results in patients with cerebral palsy

Güven

Tokyay²,

Akman³

et al. 2016

Journal of Pediatric Orthopaedics B

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The aim of this study was to report the experience with the use of a modified Grice-Green technique, which was performed using a partial subperiosteal fibular bone graft because of valgus unstable foot in children with cerebral palsy. Fifteen feet of 11 patients were evaluated on the basis of the appearance of the feet, clinical symptoms, and radiographic measurements. After an average follow-up duration of 24 (9-39) months, all feet showed satisfactory clinical and radiological results. Solid fusion and sustained correction took place in all feet. The gap at the donor site was bridged with new bone in all cases. No donor-site morbidity was detected. This modification of the Grice-Green technique can be used effectively in the correction of planovalgus foot in cerebral palsy.

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Subtalar Arthrodesis in Children

Cited by 32 publications

References 0 publications

Grice arthrodesis in the treatment of valgus feet in children with myelomeningocele: A 12.8-year follow-up study

Grice arthrodesis in the treatment of valgus feet in children with myelomeningocele: A 12.8-year follow-up study

Orthopaedic management of spina bifida—part II: Foot and ankle deformities

Modified Grice–Green subtalar arthrodesis performed using a partial fibular graft yields satisfactory results in patients with cerebral palsy

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