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Postoperative foot drop after gastrocsoleus lengthening in children with unilateral and bilateral cerebral palsy
Leonie P Bartsch1, Axel Horsch1, Marco Götze1
1Heidelberg University Hospital, Clinic for Orthopedics, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
Insights
Children with cerebral palsy (CP) undergoing calf muscle lengthening face a higher risk of foot drop, especially those with unilateral CP. Tendon transfers did not prevent this complication effectively in unilateral cases.
Area of Science:
- Pediatric Orthopedics
- Cerebral Palsy Research
- Gait Analysis
Background:
- Equinus foot deformity is common in children with cerebral palsy (CP).
- Post-calf muscle lengthening surgery, foot drop is a frequent complication, particularly in unilateral CP.
- The efficacy of concurrent tendon transfers or shortening in preventing foot drop remains unclear.
Purpose of the Study:
- To investigate the incidence of postoperative foot drop after calf muscle lengthening in children with CP.
- To evaluate the effectiveness of tendon transfers in preventing foot drop in unilateral CP cases.
Main Methods:
- Retrospective analysis of 167 children with CP (GMFCS I-III).
- Included patients underwent surgical calf muscle lengthening.
- Pre- and postoperative 3D gait analysis and clinical data were reviewed.
Main Results:
- Both unilateral and bilateral CP groups showed improved dorsiflexion post-surgery.
- Unilateral CP patients had significantly lower postoperative swing phase dorsiflexion (-6°) compared to bilateral (-1°).
- Foot drop incidence was 50% in unilateral CP vs. 16% in bilateral CP; tendon transfers did not reduce this rate.
Conclusions:
- Children with unilateral CP are at significantly higher risk of foot drop after calf muscle lengthening.
- Tendon transfers did not effectively prevent foot drop in unilateral CP and did not improve active dorsiflexion.
- Prospective studies assessing preoperative tendon-muscle function are recommended.
Background:
Equinus foot is a frequent deformity in children with cerebral palsy (CP). After calf-muscle lengthening surgery, foot drop is frequent and seems to occur mainly in unilateral CP cases. It remains unclear if this complication can be prevented with same-procedure transfer or shortening of dorsiflexor tendons.
Methods:
Retrospective analysis of 167 ambulant children with unilateral and bilateral CP, GMFCS levels I to III, who received surgical calf-muscle lengthening. Pre- and postoperative 3D instrumented gait analysis and clinical examination data were reviewed.
Results:
Stance and swing phase dorsiflexion improved in both groups. Postoperative mean swing phase dorsiflexion was significantly lower in unilaterally affected than in bilaterally affected children (median -6° vs. +1°, P < .001). The incidence of postoperative foot drop in unilaterally and bilaterally affected patients was 50 % and 16 %, respectively, with a significant group difference (P < .001). Tendon transfers did not lead to a lower rate of postoperative foot drop, but were performed in children with more severe preoperative findings.
Conclusion:
Children with unilateral CP are at a higher risk of postoperative foot drop after calf muscle lengthening than the bilaterally affected. Although the range of motion improved postoperatively, tendon transfers did not improve active dorsiflexion in children with unilateral CP and could thus not prevent foot drop effectively. Due to these findings, prospective research with preoperative assessment of tendon-muscle function is needed in this field.
