Surgical Management of Hallux Valgus Deformity in Children with Cerebral Palsy

Davids, Jon R.; Mason, Travis A.; Danko, Aileen M.; Banks, David M.; Blackhurst, Dawn

doi:10.1097/01241398-200101000-00018

Cited by 43 publications

(30 citation statements)

References 19 publications

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“…Some studies also included unique, sometimes anecdotal, measures of outcome, such as author‐developed questionnaires, to explore other aspects of impairment in body structure and function, e.g. ability to use different types of footwear, the appearance of the foot, and difficulties with hygiene, despite lack of evidence of published validity and reliability . Use of these non‐standardized measures may reflect the paucity of standardized tools available in the published literature to assess these outcomes, which are often of interest to the patient and family, as well as to surgeons …”

Section: Discussionmentioning

confidence: 99%

Reported outcomes of lower limb orthopaedic surgery in children and adolescents with cerebral palsy: a mapping review

Wilson

Chong

Mackey

et al. 2014

Develop Med Child Neuro

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Aim Lower limb surgery is often performed in ambulatory children with cerebral palsy (CP) to improve walking ability. This mapping review reports on outcome measures used in the published literature to assess surgical results, determine range and frequency of use, and map each measure to the International Classification of Functioning, Disability and Health. Method A mapped review of literature published between 1990 and 2011 was carried out to identify papers reporting the outcomes of lower limb orthopaedic surgery in ambulatory children with CP, aged 0 to 20 years. Results A total of 229 published papers met the inclusion criteria. Thirty‐two outcome measures with known psychometric properties were reported in the 229 papers. Twenty measures assess impairments in body structure and function and were used in 91% of studies. Ten measures assess restrictions in activity and participation and were used in 9% of papers. Two measures assessed quality of life. Since 1997, 29% of papers have used the Gross Motor Function Classification System to describe participants. Interpretation The body of literature evaluating outcomes of lower limb orthopaedic surgery in CP is small but increasing. There is a need to develop a suite of outcome measures that better reflect outcomes across the International Classification of Functioning, Disability and Health, including activity and participation.

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Section: Discussionmentioning

confidence: 99%

Reported outcomes of lower limb orthopaedic surgery in children and adolescents with cerebral palsy: a mapping review

Wilson

Chong

Mackey

et al. 2014

Develop Med Child Neuro

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“…The development of hallux valgus in the non-ambulatory children with cerebral palsy supports the role of foot intrinsic muscle imbalance [3]. Abnormal extrinsic factors due to the disruption of forefoot biomechanics during the stance phase of the gait cycle could also contribute to the development of hallux valgus deformity in the ambulatory children with cerebral palsy.…”

Section: Introductionmentioning

confidence: 93%

Great toe metatarsophalangeal arthrodesis for hallux valgus deformity in ambulatory adolescents with spastic cerebral palsy

Bishay

El-Sherbini

Lotfy

et al. 2009

Journal of Children's Orthopaedics

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Background Hallux valgus deformity is a common sequel of spastic cerebral palsy. Methods Twenty ambulatory patients (24 feet) suffering hallux valgus deformity, with painful forefoot and restricted footwear, secondary to spastic cerebral palsy acquired perinatally, were treated with great toe metatarsophalangeal (MTP) arthrodesis using percutaneous K-wires for fixation. The mean age at the time of surgery was 16.2 years (range 14-18 years). They were retrospectively evaluated for the results after arthrodesis at a mean interval of 3 years and 4 months (range 3-4 years) by physical examination and radiographs. Results All patients had a stable painless aligned great toe, with \10°valgus, \20°dorsiflexion and neutral rotation after arthrodesis, evidenced by improvement in pain, cosmesis, functional activity, footwear, callosities and hygiene, as well as by significant improvement in the measures of the MTP and the intermetatarsal angles (IMA) by postoperative radiographs. Neither non-union (pseudoarthrosis) nor recurrence of the deformity developed. Complications included superficial wound slough in a single case. Using the modified American Orthopaedic Foot Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale, 18 feet (75%) were classified as excellent and six feet (25%) as good. Neither fair nor poor cases were recorded. Conclusion Hallux valgus deformity in adolescents with spastic cerebral palsy is best treated by great toe MTP arthrodesis to improve segmental foot malalignment and dynamic foot deviation.

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“…Given the invasive nature of orthopedic surgeries and the frequency at which they typically occur in CP, it is reasonable to be concerned about the development of chronic postsurgical pain (CPSP) as an especially troubling outcome. 9,17,18 CPSP is defined as pain that develops or increases in intensity after a surgical procedure and persists beyond the healing process (≥3 months 19 ). In typically developing children and adolescents, CPSP affects approximately 13-42% of those undergoing predominantly orthopedic procedures 20,21 ; up to 69% experience some level of chronic pain after spinal fusions.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…While pain reduction may be a goal of orthopedic surgery in CP, 9 there is a dearth of research specific to pain outcomes from this treatment, possibly due to the challenges of obtaining self‐reported pain among the approximate 25%‐50% of individuals with cognitive or communication impairments (Novak 2012). Surprisingly, only 5% of 229 orthopedic outcome studies assessed pain prevalence 10 .…”

Section: Introductionmentioning

confidence: 99%

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Presence and predictors of pain after orthopedic surgery and associated orthopedic outcomes in children with cerebral palsy

Boyer

Novaczyk

Novacheck

et al. 2021

Paediatric and Neonatal Pain

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While children with cerebral palsy (CP) may undergo 8‐22 orthopedic surgeries in their lifetime, little is known about the associated pain. We aimed to assess the pain presence before and one year after lower extremity orthopedic surgery, predictors of pain presence at follow‐up, and the association between pain and orthopedic outcomes related to surgery. This retrospective study included 86 children with CP (M age = 10.0 years, SD = 3.2; range = 4.1‐17.3 years, Gross Motor Functional Classification System (GMFCS) level I‐III) who underwent orthopedic surgery and had completed questionnaires at gait analyses before (M = 2.7 months; range = 0.0‐5.7) and after surgery (M = 11.8 months; range = 9.0‐14.9). Pain presence, location, and Pediatric Outcomes Data Collection Instrument (PODCI) scores were documented before and after surgery at gait analyses. Pain prevalence was 60% at baseline and 56% at follow‐up. Significant predictors of pain presence at follow‐up included (1) pain presence at baseline (range of odds ratios [OR] across any/all locations = 3.22 to 15.54), (2) older age (range of OR for any pain, back, knee, and foot pain = 1.24‐1.26), (3) female sex (decreased OR for males for ankle pain = 0.12), (4) having hip surgery (decreased OR for foot pain = 0.20), and (5) lower GMFCS level (OR for foot pain = 0.41). Changes in PODCI Sports and Physical Function scores were associated with changes in hip and knee pain (P < .03); PODCI scores worsened for patients who had pain at both time points and improved for patients who had pain at baseline but not follow‐up. Pain was present for over half of the participants before and after orthopedic surgery. Pain presence at follow‐up was predicted by pain presence at baseline. Pain and functional outcomes were correlated at follow‐up. Prospective studies examining perioperative pain experience and factors predicting pain outcomes are warranted.

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Surgical Management of Hallux Valgus Deformity in Children with Cerebral Palsy

Cited by 43 publications

References 19 publications

Reported outcomes of lower limb orthopaedic surgery in children and adolescents with cerebral palsy: a mapping review

Reported outcomes of lower limb orthopaedic surgery in children and adolescents with cerebral palsy: a mapping review

Great toe metatarsophalangeal arthrodesis for hallux valgus deformity in ambulatory adolescents with spastic cerebral palsy

Presence and predictors of pain after orthopedic surgery and associated orthopedic outcomes in children with cerebral palsy

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