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Prevalence and classification of equinus foot in bilateral spastic cerebral palsy
Axel Horsch1, Marco Götze2, Andreas Geisbüsch2
1Heidelberg University Hospital, Clinic for Orthopedics and Trauma Surgery, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany. axel.horsch@med.uni-heidelberg.de.
Insights
Fixed equinus foot contractures are highly prevalent in children with bilateral spastic cerebral palsy (BSCP). Differentiating gastrocnemius and gastrosoleus involvement is crucial for effective surgical treatment.
Area of Science:
- Orthopedics
- Pediatric Neurology
- Biomechanical Engineering
Background:
- Equinus foot deformity is common in children with bilateral spastic cerebral palsy (BSCP).
- Dynamic equinus often responds to conservative treatment, but fixed contractures require surgical intervention.
- Accurate surgical planning necessitates distinguishing between isolated gastrocnemius shortening and combined gastrosoleus complex contracture.
Purpose of the Study:
- To determine the prevalence of fixed equinus foot in patients with BSCP.
- To classify fixed equinus based on the involvement of gastrocnemius and gastrosoleus muscles.
- To evaluate the utility of clinical examination and gait analysis in differentiating contracture types.
Main Methods:
- Retrospective study of 938 patients with BSCP.
- Gait analysis and clinical examination performed on 248 eligible patients (496 limbs).
- Data used to calculate prevalence and classify fixed equinus foot contractures.
Main Results:
- Equinus deformity prevalence was 83.3% in the studied BSCP population.
- Combined gastrosoleus complex contracture observed in 59.6% of limbs, isolated gastrocnemius in 40.4%.
- Reduced maximum dorsiflexion and mean dorsiflexion at initial contact were noted in combined contractures.
Conclusions:
- High prevalence of fixed equinus in BSCP patients confirmed, correlating with increasing age.
- Approximately half of fixed equinus cases involve differential muscle involvement (gastrocnemius vs. soleus).
- Silfverskiöld's test is recommended to differentiate contracture types for optimal surgical selection.
Background:
Equinus is a common deformity in children with bilateral spastic cerebral palsy (BSCP). While dynamic equinus usually is treated by conservative therapy, fixed contractures need surgical correction. To choose the appropriate surgical method, it is important to discriminate between isolated gastrocnemius shortening and combined gastrosoleus complex contracture.
Methods:
In a retrospective study 938 patients with BSCP were studied. Patients underwent gait analysis and clinical examination. 248 patients (496 limbs) met the inclusion criteria. Data from motion analysis and clinical examination were used to calculate the prevalence and to further classify fixed equinus foot.
Results:
The prevalence of equinus was 83.3%. During clinical exam 246 (59.6%) limbs showed combined gastrosoleus complex contracture and 167 (40.4%) isolated gastrocnemius contracture. Max. DF at stance and mean DF at initial contact were significantly reduced in combined contracture, while max. ROM was increased (P < 0.05).
Conclusions:
Corroborating the results of previous studies, in this study there was a high prevalence of fixed equinus in patients with BSCP. The prevalence of equinus correlated with increasing age. As half of the patients with fixed equinus show a different involvement of gastrocnemius and soleus muscle, we recommend to apply Silfverskiöld's test to discriminate between those two types to choose the appropriate surgical therapy.
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