Calcaneal lengthening for the planovalgus foot deformity in children with cerebral palsy

The authors studied the outcomes of calcaneal lengthening for the treatment of planovalgus foot deformity in ambulatory children with cerebral palsy (92 feet in 56 children, mean age 9.2 years), attempting to define the surgical indication in terms of the severity of the foot deformity. Sixty-nine cases (75%) showed satisfactory clinical outcomes at an average follow-up of 5.2 years (range 4.0-17.2 years). Gait parameters such as foot progression angle, ankle motion in sagittal plane, and its power generation improved after operation. Preoperative talocalcaneal angle, talo--first metatarsal angle, and calcaneal pitch on weight-bearing lateral radiographs were predictive of the satisfactory results of the index operation. The authors conclude that calcaneal lengthening is an effective procedure for moderate to severe planovalgus foot deformities in children with cerebral palsy, but there is a limit under which the index operation can be performed safely: less than 35 degrees of talocalcaneal angle, less than 25 degrees of talo--first metatarsal angle, and more than 5 degrees of calcaneal pitch on weight-bearing lateral radiographs.