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Calcaneal lengthening for planovalgus deformity in children with cerebral palsy
Volker Ettl1, Nicole Wollmerstedt, Stephan Kirschner
1Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Department of Orthopeadics, Brettreichstrasse 11, Wuerzburg 97074, Germany. v-ettl.klh@uni-wuerzburg.de
Background:
In children with cerebral palsy, planovalgus deformity of the foot is common. The aim of this study was to evaluate the outcome of calcaneal lengthening for the treatment of planovalgus foot deformity in children with cerebral palsy.
Materials And Methods:
We reviewed 19 children (28 feet) treated between 1996 and 2004 in our institution. There were 14 ambulating (19 feet) and 5 nonambulating children (9 feet). The average age of the children at time of surgery was 8.6 years. Followup averaged 4.3 years.
Results:
We found satisfactory results in 75% of the feet clinically and in 79% radiologically according to Mosca's criteria. We saw no overcorrection but a relapse of the deformity in seven cases. There were six unsatisfactory radiological results, two (out of 19) in the ambulating and four (out of nine) in the nonambulating group. Ambulating children had a significantly better clinical and radiological outcome than nonambulating children (p = 0.042). A significant correlation was found between Ankle-hindfoot Score and clinical result according to Mosca's criteria (p = 0.001).
Conclusion:
In ambulatory children with cerebral palsy calcaneal lengthening is an effective procedure for the correction of mild to moderate planovalgus foot deformities. In nonambulatory children with severe plano-valgus deformities of the foot, calcaneal lengthening cannot be recommended because of the high relapse rate in these patients.