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Corrective Efficacy of Calcaneal Lengthening Osteotomy for Planovalgus Deformity in Cerebral Palsy Patients
Vinod Dubey1, Sohilkhan R Pathan2, Dhruv Sharma1
1Orthopaedic Surgery, Shree Krishna Hospital and Medical Research Centre, Pramukhswami Medical College, Bhaikaka University, Anand, IND.
Insights
Calcaneal lengthening osteotomy (CLO) effectively corrects planovalgus foot deformity in children with cerebral palsy (CP). Outcomes are influenced by patient age, motor function (GMFCS level), and other health conditions.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Biomechanical Analysis
Background:
- Planovalgus foot deformity is a common complication in pediatric patients with spastic cerebral palsy (CP), impacting mobility and requiring effective interventions.
- Muscle imbalance in immature foot skeletons leads to hindfoot valgus and forefoot abduction, necessitating surgical correction like calcaneal lengthening osteotomy (CLO).
- Objective guidelines for utilizing CLO in CP patients are currently lacking, highlighting the need for evidence-based practice.
Purpose of the Study:
- To evaluate the efficacy of calcaneal lengthening osteotomy (CLO) in correcting planovalgus foot deformity in pediatric cerebral palsy (CP) patients.
- To analyze the radiographic outcomes and identify factors influencing the success of CLO.
- To provide insights into the biomechanical effects of CLO on foot structure in CP.
Main Methods:
- A retrospective cohort study was conducted involving pediatric CP patients who underwent CLO.
- Radiographic data, including pre- and postoperative angles, were collected and analyzed.
- Statistical analysis assessed the changes in specific angles and their correlation with patient demographics and clinical factors like GMFCS level.
Main Results:
- CLO significantly improved calcaneal pitch, lateral talo-first metatarsal angle, and naviculocuboid overlap.
- Tibiocalcaneal angles did not demonstrate significant postoperative changes.
- Age, GMFCS level, and the presence of comorbidities were associated with variations in postoperative correction.
Conclusions:
- Calcaneal lengthening osteotomy (CLO) is a promising surgical option for correcting planovalgus deformity in pediatric CP.
- Patient factors such as age, GMFCS level, and comorbidities significantly influence surgical outcomes.
- Long-term follow-up studies are essential to confirm the durability of CLO correction and optimize treatment strategies for CP patients.
Abstract:
Introduction Planovalgus deformity is common in children with spastic cerebral palsy (CP), particularly spastic diplegia and spastic quadriplegia. It results from muscle imbalance over the immature foot skeleton, leading to hindfoot valgus, forefoot abduction, and joint subluxation. Surgical interventions, like calcaneal lengthening osteotomy (CLO), are frequently employed to correct this deformity, but objective guidelines for its use in CP patients are lacking. Material and methods This retrospective cohort study examined the efficacy of CLO in correcting plano valgus deformity in pediatric CP patients at the Pediatric Orthopedic Unit of Christian Medical College (CMC) in Vellore, India. Data from patient records and radiographs were collected, including demographics, pre- and postoperative angles, and surgical details. Statistical analysis was performed to assess changes in angles and associations with various factors. Results After the surgery, there was a notable enhancement in the calcaneal pitch, lateral talo-first metatarsal angle, and naviculocuboid overlap, as shown by the CLO results. However, tibiocalcaneal angles did not show significant changes. Associations were observed between age, Gross Motor Function Classification System (GMFCS) level, additional surgeries, and postoperative angle corrections. Conclusion CLO shows promise in correcting plano valgus deformity, with age, GMFCS level, and comorbidities influencing outcomes. Long-term follow-up is crucial to monitor correction durability. Specific radiographic angles provide insights into CLO's biomechanical effects, but study limitations warrant caution in interpretation. CLO effectively corrects plano valgus deformity in pediatric CP patients, with age, GMFCS level, and comorbidities influencing outcomes. Long-term follow-up and further research are needed to optimize management strategies and enhance understanding of surgical outcomes.
