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Can persistent drop foot after calf muscle lengthening be predicted preoperatively?
Bjørn Lofterød1, Merete Aarsland Fosdahl, Terje Terjesen
1Section for Child Neurology, Department of Paediatrics, Rikshospitalet University Hospital, Sognsvannsveien 20, Oslo, Norway. bjorn.lofterod@rikshospitalet.no
Insights
Calf muscle lengthening surgery for cerebral palsy can leave some children with a persistent drop foot during the swing phase. Preoperative ankle plantar flexion and motor control predict successful swing phase function.
Area of Science:
- Orthopedics
- Pediatric Gait Analysis
- Cerebral Palsy Research
Background:
- Calf muscle lengthening effectively corrects equinus gait in the stance phase for children with cerebral palsy.
- However, a significant proportion of patients experience persistent drop foot during the swing phase post-surgery.
Purpose of the Study:
- To identify preoperative clinical and biomechanical predictors of postoperative drop foot in the swing phase.
- To improve surgical outcomes for children with cerebral palsy undergoing gait correction.
Main Methods:
- Retrospective analysis of 34 children with cerebral palsy undergoing calf muscle lengthening.
- Inclusion criteria: preoperative ankle dorsiflexion more than 2 standard deviations below normal.
- Preoperative and postoperative clinical examinations and gait analysis were performed.
Main Results:
- Nineteen of 40 limbs (47.5%) exhibited postoperative drop foot despite satisfactory stance phase correction.
- Increased preoperative maximum plantar flexion in initial swing was significantly associated with postoperative drop foot (P = .004).
- Normal preoperative selective motor control of ankle dorsiflexion predicted a normal swing phase postoperatively.
Conclusions:
- Preoperative maximum plantar flexion in initial swing < -42 degrees and normal selective motor control of ankle dorsiflexion are strong indicators of a normal postoperative swing phase.
- Preoperative clinical findings, gait pattern, or surgical technique did not significantly predict swing phase outcomes.
- Selective motor control assessment is crucial for predicting swing phase function in pediatric cerebral palsy gait surgery.
Unlabelled:
Calf muscle lengthening usually corrects equinus gait satisfactorily in stance. While in swing, the foot remains in drop foot in approximately half the limbs. The aim of this study was to evaluate if any preoperative clinical findings or kinematic and kinetic data could predict the outcome regarding drop foot. The study included 34 children with cerebral palsy. The average age was 9.3 years. Only children with preoperative maximum ankle dorsiflexion in stance and maximum ankle dorsiflexion in swing more than 2 standard deviations below the normal mean were included. The children underwent preoperative and postoperative clinical examination and gait analysis. Forty calf muscle lengthenings were performed (26 tendo-achilles lengthenings, 14 gastrocnemius recessions). Nineteen of 40 limbs remained in drop foot despite satisfactory correction in stance. There was a significant association between postoperative drop foot and increased preoperative maximum plantar flexion in initial swing (P = .004; odds ratio, 0.906). A limited number of tests of preoperative selective motor control of dorsiflexion of the ankle indicated that normal function is strongly indicative of postoperative normal swing phase. There were no significant associations between postoperative drop foot and preoperative clinical findings, gait function, type of gait pattern, type of cerebral palsy, and type of operation. Preoperative maximum plantar flexion in an initial swing of less than -42 degrees and a preoperative normal selective motor control of dorsiflexion of the ankle are strongly indicative of postoperative normal swing phase. A lower selective motor control score rather than normal function is not predictive of either normal swing or drop foot.
Level Of Evidence:
2.
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