Surgical Management of Foot and Ankle Deformities in Cerebral Palsy

Bloom, Tamir; Sabharwal, Sanjeev

doi:10.1016/j.cpm.2021.09.001

Cited by 5 publications

(4 citation statements)

References 67 publications

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“…This is confirmed in previous reports, which found equinus as one of the most recognized foot deformities in children with CP leading directly to limited heel pressure. 19 , 27 In addition to equinus, excessive knee flexion as seen in jump gait and apparent equinus gait could also contribute to low heel impulse. 7 , 8 Lower heel pressure is present among all GMFCS levels but typically improves in GMFCS levels I–III with treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Poorly timed surgery poses a threat of deformity recurrence or overcorrection with the potential need for revision surgery. 27 At our center, surgical foot deformity correction is performed only after bracing becomes intolerable due to progressive deformity, which in children at GMFCS level I–II was age 13.0 (± 3) years (tendon lengthening /transfer or bony correction), and at level III, it was age 11.8 (± 2.4) years (bony correction). Only two varus corrections were completed below age 10 years and only one valgus correction occurred in a child below age 10 years ( Figure 1(a) ).…”

Section: Discussionmentioning

confidence: 99%

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Changes in foot posture evaluated with dynamic pedobarography over the course of childhood in ambulatory youth with cerebral palsy

Church,

Lennon,

Lennon

et al. 2024

Journal of Children's Orthopaedics

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Purpose: Foot deformities are prevalent in children with cerebral palsy, but there is limited research on the progression of foot posture during growth. Our study aimed to evaluate the change in dynamic foot posture in children with cerebral palsy. Methods: Children with cerebral palsy, aged 17–40 months, were recruited to participate in this Institutional Review Board–approved prospective longitudinal study by having serial foot posture evaluations. The coronal plane index and foot segmental impulses were measured with dynamic pedobarography. Data were compared between children stratified by Gross Motor Function Classification System level and typically developing children using serial Welch’s t-tests across time with Holm correction for multiple comparisons. Results: In total, 33 children (54 limbs) were included in the analysis (21 bilateral and 12 unilateral; Gross Motor Function Classification System: I-13, II-14, III-4, IV-2. Children completed 16.9 (± 4.4) evaluations (initial age 2.9 (± 0.7) and final age 18.6 (± 1.7) years)). Early valgus foot posture normalizes in children at Gross Motor Function Classification System levels I/II and persists in children at levels III/IV who do not have foot surgery. For most young children, foot posture development is variable. Conclusion: Foot posture in young children with cerebral palsy begins in valgus and tends to normalize in youth who walk without an assistive device. Conservative management of foot deformity is recommended in early childhood. Level of evidence: Level II, prognostic study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Changes in foot posture evaluated with dynamic pedobarography over the course of childhood in ambulatory youth with cerebral palsy

Church,

Lennon,

Lennon

et al. 2024

Journal of Children's Orthopaedics

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“…These velocity-dependent repetitive muscle contractions can lead to limitations in force exertion and joint range of motion (ROM) ( Farmer and James, 2001 ; Wren et al, 2005 ). In the lower limb, triceps surae muscle spasticity resulting in foot deformities such as pes equinus or pes equinovarus are common manifestations ( Horsch et al, 2019 ; Bloom and Sabharwal, 2022 ) with possible deterioration of the patients’ ability to stand or walk independently ( Prabhu et al, 2013 ; Attias et al, 2016 ). Muscle shortening and associated joint movement problems are not limited to patients with spastic CP and neurological conditions.…”

Section: Introductionmentioning

confidence: 99%

Quantifying the effects of achilles tendon lengthening surgery: An intraoperative approach

Brendecke

Tsitlakidis²,

Götze³

et al. 2023

Front. Physiol.

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Achilles tendon lengthening (ATL) is frequently used in the treatment of foot deformities. However, there is currently no objective method to determine the optimal muscle length during surgery. We developed an intraoperative approach to evaluate the passive and active forces of the triceps surae muscle group before and after ATL and aimed to test the following hypotheses: 1) the ankle passive range of motion (ROM) increases, 2) passive muscle forces decrease post-ATL, and 3) forces measured from patients with non-neurological and neurological conditions demonstrate different characteristics. Passive forces at various ankle joint positions were measured in ten patients (11.3 ± 3.0 years old) pre- and post-ATL using a force transducer attached to the Achilles tendon. In six patients, active isometric forces were measured by stimulating the triceps surae supramaximally. Passive forces decreased by 94.3% (p < 0.0001), and ROM increased by 89.4% (p < 0.0001) post-ATL. The pre-ATL passive forces were 70.8% ± 15.1% lower in patients with idiopathic foot deformities than in patients with neurological conditions (p < 0.001). The peak active force of 209.8 ± 114.3 N was achieved at an ankle angle of 38.3° ± 16.0°, where the passive force was 6.3 ± 6.7 N. The inter-individual variability was substantial in both groups. In conclusion, the hypotheses posed were supported. The present findings suggest that muscle passive and active force production as well as the inter-individual variability should be considered when planning further treatment.

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“…Spasticity of the lower extremities can lead to toe-in gaits and crouch gaits, which can lead to falling and unstable balance while walking [ 4 ]. People with CP have difficulty walking due to foot deformities and poor control of their muscles and motor skills [ 5 ]. Deformities of the feet are common in people with CP, resulting in unnatural foot landings and abnormal foot pressure distributions, as well as changes in posture and gait [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Traceable Features of Static Plantar Pressure Characteristics and Foot Postures in College Students with Hemiplegic Cerebral Palsy

Chow

2022

JPM

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Patients with cerebral palsy (CP) are characterized by disturbances of mobility with postural and foot deformities. Subsequent development of CP may lead to changes in plantar loading. This study examined the characteristics of foot types and relative loads associated with centers of gravity and foot posture in college students with left and right hemiplegic CP, as well as these differences between unaffected and hemiplegic limbs. A cross-sectional study of 45 hemiplegic college students with mild CP and 62 healthy students was conducted. Static plantar pressure was measured with a JC Mat. CP students exhibited low arches, and their plantar pressure distributions (PPDs) were mainly exerted on the left forefoot, as well as on the right forefoot and rearfoot. The weight shifted to the unaffected foot with dual plantar loading regions (forefoot and rearfoot), rather than the hemiplegic foot with a single region (forefoot). PPDs commonly increased at the medial metatarsals of both feet, and hemiplegic CP students presented the increased PPDs on the medial aspect of the hemiplegic foot accompanied by a rearfoot valgus posture pattern. The findings revealed a traceable feature to a possible connection among the pronated low arches, mild centers of gravity, metatarsal syndrome and rearfoot valgus of the hemiplegic limbs in CP patients.

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Surgical Management of Foot and Ankle Deformities in Cerebral Palsy

Cited by 5 publications

References 67 publications

Changes in foot posture evaluated with dynamic pedobarography over the course of childhood in ambulatory youth with cerebral palsy

Changes in foot posture evaluated with dynamic pedobarography over the course of childhood in ambulatory youth with cerebral palsy

Quantifying the effects of achilles tendon lengthening surgery: An intraoperative approach

Traceable Features of Static Plantar Pressure Characteristics and Foot Postures in College Students with Hemiplegic Cerebral Palsy

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