Calcaneal lengthening osteotomy in spastic planovalgus feet

Area of Science:

• Pediatric Orthopedics
• Cerebral Palsy Management
• Foot and Ankle Surgery

Background:

• Planovalgus deformity in cerebral palsy significantly impacts a child's mobility and energy expenditure during gait.
• Loss of foot lever arm function and Achilles tendon disadvantage contribute to gait dysfunction.
• Evaluating surgical interventions is crucial for improving functional outcomes.

Purpose of the Study:

• To assess the clinical, radiological, and gait parameter outcomes of calcaneal lengthening osteotomy in children with cerebral palsy and planovalgus deformity.
• To determine the efficacy of this surgical technique in correcting foot deformities and improving gait mechanics.

Main Methods:

• A study involving 17 spastic feet in 10 children classified by the Gross Motor Function Classification System (GMFCS).
• Clinical assessments included heel valgus and heel rise tests.
• Radiological measurements (Talo-calcaneal, Talo-navicular coverage, Calcaneal pitch, Calcaneus-5th metatarsal, Talus-1st metatarsal angles) and video gait analysis (knee progression and flexion angles) were performed.

Main Results:

• Significant clinical improvement in heel valgus angle (preop 12.06°, postop 5.12°).
• Radiological evidence of improved talar coverage by the navicular and elevation of the medial longitudinal arch.
• Gait analysis revealed a trend towards decreased knee flexion in mid and terminal stance, indicating improved knee axis restoration.

Conclusions:

• Calcaneal lengthening osteotomy, combined with peroneus brevis lengthening, effectively addresses planovalgus deformity in cerebral palsy.
• The procedure leads to improved gait patterns without compromising joint range of motion.
• It is a safe and effective surgical option for GMFCS grade 1 and 2 patients with minimal complications.