Talonavicular joint arthrodesis for the treatment of pes planus valgus in older children and adolescents with cerebral palsy

Turriago, Camilo; Arbeláez, Myriam Fernanda; Becerra, Luis Carlos

doi:10.1007/s11832-009-0168-7

Cited by 24 publications

(31 citation statements)

References 21 publications

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“…Our approach from the medial side was based on the intention to correct the bones at the site of the main deformity, and internal fixation was used to maintain the ''new arch'' until bone union was achieved. The preference for the medial approach is shared by Turriago et al [23], although the medial arthrodesis performed by them was more limited. A high incidence of failure to correct the deformity is reported in 23.5% [23] to 52% [22] of cases undergoing triple arthrodesis, which clearly shows the difficulty in achieving and maintaining correction of the deformity in these rigid feet.…”

Section: Discussionmentioning

confidence: 99%

“…The preference for the medial approach is shared by Turriago et al [23], although the medial arthrodesis performed by them was more limited. A high incidence of failure to correct the deformity is reported in 23.5% [23] to 52% [22] of cases undergoing triple arthrodesis, which clearly shows the difficulty in achieving and maintaining correction of the deformity in these rigid feet. Radiographic evaluation of these severe deformities is difficult, and it is usually hard to obtain good images in the weightbearing position in a nonambulatory patient.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Technique: Medial Column Arthrodesis in Rigid Spastic Planovalgus Feet

Fucs

Svartman

Assumpção

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Treatment of spastic planovalgus feet is challenging, especially in patients with severe and rigid deformities. The available techniques do provide some correction but not at the site of the deformity and sometimes the correction is lost over time. We describe a new surgical approach at the site of the deformity. Technique Indications for the surgery included adolescents or young adults with severe and rigid planovalgus deformities of the feet resulting from cerebral palsy. Through a medial approach, arthrodesis of the talonavicular, navicular-medial cuneiform, and medial cuneiform first metatarsal joints was internally fixed using a single-molded plate over the plantar surface of the foot, recreating the longitudinal arch.Methods We retrospectively reviewed 21 patients (35 feet) with spastic cerebral palsy in whom the new technique was indicated for severe and rigid deformity, gait dysfunction, and pain (mean age, 190 months; range, 96-345 months). The mean age of the patients was 16 years (range, 8-29 years). We analyzed the patients clinically and radiographically. The minimum followup was 2.5 years (mean, 58 months; range, 2.5-7.5 years). Results At last followup, 34 of the 35 feet (97%) had radiographic improvement of the deformity with no difficulties wearing shoes; one patient had persistent pain despite bone union. Union was achieved initially in eight patients (17 feet) and in another eight (10 feet) after revision surgery, of 27 of the 35 feet. The radiographic calcaneal inclination angle improved an average of 13°. The lateral talocalcaneal angle decreased from a mean of 43°to 26°after surgery. Four patients (five feet) had revision surgery for pseudoarthrosis, and another four patients (five feet) had revision surgery for other problems. Conclusions Based on our preliminary observations, we believe stabilization of the medial column is a reasonable option for treating selected patients with severe and rigid planovalgus feet by providing a stable and pain-free foot, recreating the anatomy, and allowing the use of braces or regular shoes. Further studies with longer followup periods will be required to confirm these initial results and to verify if these findings persist over time.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Technique: Medial Column Arthrodesis in Rigid Spastic Planovalgus Feet

Fucs

Svartman

Assumpção

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…The deformity often progresses because of increased body mass and foot load in ambulatory children or because of long-standing muscle imbalance in less ambulatory children. In more severe cases, the medial column can be stabilized by talonavicular fusion [28][29][30]. The goal of treatment is to establish a plantigrade, stable foot by restoring a correct relationship between the tarsal bones and restoring more normal foot progression angle during gait.…”

Section: Planovalgus Deformitymentioning

confidence: 99%

Foot deformities in children with cerebral palsy

Kedem

Scher²

2015

Current Opinion in Pediatrics

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Foot deformities are common among children with cerebral palsy. The three most common among them are equinus, planovalgus and equinovarus/equinocavovarus. Treatment consists of orthotics, physical therapy, spasticity reduction treatment and surgical correction. Guidelines for treatment are individualized and multifactorial. Important considerations include the child's level of function, the severity and flexibility of the deformity, the presence or absence of pain and skin irritation, and the changes in alignment observed over time.

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“…При выполнении трехсуставного артродеза стопы наиболее частым осложнением является отсутствие сращение в зоне одного или нескольких суставов после данной операции. Так, у детей частота несращения составляет до 23% [6,10,12,15,25,29], у взрослых -до 46% [16,29,34,37]. При этом почти у 40% больных манифестирует это болью в стопе [15].…”

Section: Discussionunclassified

“…Детям старшего возраста и взрослым с деформациями стоп рекомендуют выполнять корригирующие остеотомии костей стопы, артроэрез, стабилизирующие операции [2][3][4][9][10][11][12][13]. Однако реконструктивное вмешательство на стопе за счет остеотомии при ригидных выраженных деформациях костей и изменениях суставного хряща (остеоартроз 2-3 ст.)…”

Section: Introductionunclassified

Correction of Foot Deformities using Triple Arthrodesis and Its Effect on Soft Tissue Blood Supply at Surgical Site in Patients with Cerebral Palsy

Leonchuk

Щурова

Popkov

et al. 2018

Traumatology and Orthopedics of Russia

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The aim of the studyis to evaluate the efficiency of triple arthrodesis of foot and its effect on soft tissues blood supply at the surgical site during simultaneous correction of segment deformity in patients with cerebral palsy.Material and Methods. The present study reflects the authors’ experience of triple arthrodesis for correction and stabilization of foot multicomponent deformities of varying severity in 75 patients (136 feet) with cerebral palsy (IIIV level by Gross Motor Function Classification System (GMFCS)) treated in the Ilizarov center in the period from April 2012 to December 2016. The average age of the patients was 16.4±4.3 years (from 11 years 8 months to 43 years 3 months). All patients included into the study had severe arthrosis of hind and midfoot. The main option of foot fixation in this group of patients was internal fixation (elastic threaded wires, compression screws) together with plaster cast immobilization for 6–8 weeks. All patients underwent average of 4.59 surgical elements during a procedure as part of simultaneous multilevel interventions. The blood supply at the surgical site was evaluated by laser and high-frequency Doppler flowmetry before and after all stages of the surgery.Results.Long-term outcomes were evaluated at the average of 19 months after the surgery in 56 (74.7%) patients. 37 patients (66.1%) demonstrated good treatment outcomes and 19 patients (33.9%) — satisfactory outcomes. No unsatisfactory outcomes were observed. The clinical outcome of foot surgery was evaluated using the Angus-Cowell criteria. The obtained significant x-ray enhancement was maintained at the control stages of the follow up. Despite large simultaneous correction of foot deformity, there was no decrease in the parameters of microcirculatory blood supply of the skin, muscles and subcutaneous fat of the foot. The authors observed a stabilized or an increased perfusion of soft tissues.Conclusion.Triple arthrodesis for correction of foot deformities in patients with cerebral palsy and severe arthrosis in hind and midfoot is an efficient method which allows to correct and stabilize gained position of segments. The data of physiological research testify the sparing approach of such procedure and a possibility of an earlier weight-bearing on operated limb.

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Talonavicular joint arthrodesis for the treatment of pes planus valgus in older children and adolescents with cerebral palsy

Cited by 24 publications

References 21 publications

Surgical Technique: Medial Column Arthrodesis in Rigid Spastic Planovalgus Feet

Surgical Technique: Medial Column Arthrodesis in Rigid Spastic Planovalgus Feet

Foot deformities in children with cerebral palsy

Correction of Foot Deformities using Triple Arthrodesis and Its Effect on Soft Tissue Blood Supply at Surgical Site in Patients with Cerebral Palsy

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