Talonavicular Fusion in the Treatment of Planovalgus Foot in Ambulatory Children With Cerebral Palsy

Planovalgus is a common foot deformity in cerebral palsy (CP), and surgical correction may be warranted when it becomes symptomatic in daily activities, interferes with brace/shoe wear, or causes substantial lever-arm dysfunction. The purpose of this study was to report the outcomes of talonavicular fusion based on radiographic measures and instrumented gait analysis.

In an IRB-approved retrospective study, ambulatory children with CP (GMFCS II/III) who underwent talonavicular fusion for the treatment of planovalgus foot from 2018 to 2022 were included. Patients who had pre- and 1-year post-operative instrumented gait studies were selected from this cohort. Several radiographic measures, gait parameters, and the Gait Deviation Index were calculated and compared.

Thirteen patients with 26 feet were included in the final analysis with a mean age of 10.2 years (range, 7-15 years) at the time of surgery. At final follow-up, all radiographic measures showed significant improvement, including the AP talus-first metatarsal angle (pre-op 21.4° ± 4.8, post-op 5.5° ± 2.7, P < .001) and the lateral talus-first metatarsal angle (pre-op 22.9° ± 4.2, post-op 5.7° ± 2.0, P < .001). Spatio-temporal gait parameters did not show significant changes, but the GDI had a significant improvement. Overall, there were 3 adverse outcomes, none of which required a return to the operating room.

We found significant improvements in radiographic outcomes and a high rate of parent satisfaction at final follow-up. Gait parameters did not show significant changes, but there was a significant improvement in GDI. Our findings suggest that talonavicular fusion is a viable option in patients with GMFCS II/III function levels with symptomatic planovalgus foot, has a low complication rate, and is technically less demanding than subtalar or triple fusion.

(1)Planovalgus foot in cerebral palsy is common, but there is no consensus on the ideal surgical indications or technique.(2)Joint-sparing techniques, isolated fusions, and triple arthrodesis have been reported in planovalgus CP foot with varying success.(3)This is the first study to report the outcomes of talonavicular fusion in GMFCS II/III patients.(4)We found an improved Gait Deviation Index after talonavicular fusion, which suggests improved gait biomechanics.(5)Talonavicular fusion is technically less demanding than a triple fusion, while providing significant, sustained clinical and radiographic improvements.

Level III: Retrospective cohort study.