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Split posterior tibial-tendon transfers in children with cerebral spastic paralysis and equinovarus deformity
Insights
This study on cerebral spastic paralysis in children found that splitting the posterior tibial tendon and transferring it laterally improved equinovarus foot deformity long-term. Most patients achieved good results, with functioning dorsiflexors and no need for braces.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Equinovarus foot deformity is a common challenge in children with cerebral spastic paralysis.
- Existing treatments like heel-cord lengthening may require supplementary procedures for optimal correction.
Purpose of the Study:
- To evaluate the long-term efficacy of a specific surgical technique for correcting equinovarus foot deformity in pediatric cerebral spastic paralysis.
- To assess functional outcomes and recurrence rates following the described tendon transfer procedure.
Main Methods:
- A cohort of thirty-one children with cerebral spastic paralysis underwent a surgical procedure involving splitting the posterior tibial tendon and transferring its posterior half laterally.
- The posterior tibial tendon transfer was performed to supplement heel-cord lengthening.
- Follow-up was conducted for a mean of eight years (range, 4-14 years), with assessment of functional outcomes and deformity recurrence.
Main Results:
- Thirty-seven operations were performed, yielding thirty excellent, four good, and three poor results.
- The positive outcomes did not deteriorate over the follow-up period.
- Children with good or excellent results typically had restored dorsiflexor function and were able to discontinue brace use.
Conclusions:
- Posterior tibial tendon transfer is an effective surgical option for managing equinovarus foot deformity in children with cerebral spastic paralysis.
- The procedure demonstrates durable results, improving foot function and reducing the need for orthotic devices.
- Recurrence of deformity was noted in cases with poor outcomes, but no adverse development of calcaneal or calcaneovalgus deformities was observed.
Abstract:
In the treatment of equinovarus deformity of the foot in children with cerebral spastic paralysis, to supplement heel-cord lengthening, we split the posterior tibial tendon and transferred its posterior half laterally into the peroneus brevis tendon. Thirty-seven operations were performed on thirty-one hemiplegic, quadriplegic, and diplegic children who were followed for a mean of eight years postoperatively (range, four to fourteen years), at which time twenty-six of the thirty-one children were skeletally mature. There were thirty excellent, four good, and three poor results. The results did not deteriorate with time. Thirty-two of thirty-four children with good or excellent results had functioning dorsiflexors of the foot and were brace-free postoperatively. The children who had a poor result had recurrent deformity, but none had development of a calcaneal or calcaneovalgus deformity.