The foot and ankle in cerebral palsy

Clinical decision making for the management of foot deformities in children with cerebral palsy is based on the collection and integration of data from 5 sources: the clinical history, physical examination, plain radiographs, observational gait analysis, and quantitative gait analysis (which includes kinematic/kinetic analyses, dynamic electromyography, and dynamic pedobarography). The 3 most common foot segmental malalignments in children with CP are equinus, equinoplanovalgus, and equinocavovarus. The 2 most common associated deformities are ankle valgus and hallux valgus. Foot and ankle deformities caused by dynamic overactivity and imbalance of muscles are best treated with pharmacologic or neurosurgical interventions designed to manage muscle tone and spasticity, or muscle tendon unit transfers. Deformities caused by fixed or myostatic soft tissue imbalance without fixed skeletal malalignment are best treated with muscle tendon unit lengthening surgery. Deformities characterized by structural skeletal malalignment associated with fixed or myostatic soft tissue imbalance are best treated with a combination of soft tissue and skeletal surgeries.