Tibiotalocalcaneal arthrodesis for severe calcaneovalgus deformity in cerebral palsy

The authors studied the outcome of a consecutive series of nine tibiotalocalcaneal fusions for severe calcaneovalgus deformity in five adolescents with severe cerebral palsy. The indications for surgery were severe deformity, pain, brace intolerance, difficulties with shoe wear, and progressive loss of transfer, standing, or walking ability. The goals of surgery were deformity correction, reduced bracing, and ability to wear regular shoes and to maintain function. Successful correction of deformity was achieved in all patients. One patient had a stable fibrous ankylosis despite revision surgery. Functional goals were fully achieved in three patients and partially achieved in two patients. The authors conclude that tibiotalocalcaneal fusion is useful as a salvage procedure in a small group of adolescents to correct severe deformity and to maintain limited function. Isolated lengthening of the tendo Achillis had been performed in four of these patients and was a contributing factor to the development of this deformity.