Related Experiment Video
Updated: Aug 6, 2026
Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy
Published on: August 9, 2024
Calcaneal Lengthening Osteotomy in Cerebral Palsy: Does Age at Intervention Influence Outcomes?
David E Westberry1, Jacob M Bailey1, Emily R Shull1
1Shriners Children's-Greenville, Greenville, SC.
Insights
Age at surgery for calcaneal lengthening osteotomy in children with cerebral palsy does not impact long-term outcomes. This study found no significant differences in radiographic correction, revision rates, or pain between younger and older surgical cohorts.
Area of Science:
- Pediatric Orthopedics
- Cerebral Palsy Management
- Foot and Ankle Surgery
Background:
- The optimal timing for calcaneal lengthening osteotomy (CLO) in pediatric cerebral palsy (CP) patients is debated.
- Limited long-term data exists on recurrence or overcorrection risks associated with younger surgical age.
Purpose of the Study:
- To evaluate the influence of surgical age on long-term radiographic maintenance and clinical outcomes of CLO in children with CP.
- To compare outcomes between children undergoing CLO at or before 8 years versus after 8 years of age.
Main Methods:
- Retrospective review of 102 patients (155 feet) with CP undergoing CLO (1990-2020).
- Minimum 5-year radiographic follow-up; patients stratified into two age cohorts: ≤8 years and >8 years.
- Radiographic parameters, revision rates, pain, and pedobarographic data analyzed.
Main Results:
- Both age cohorts demonstrated significant postoperative radiographic improvements with sustained correction at long-term follow-up.
- No significant differences in revision surgery rates (11.8% younger vs. 7.1% older) or persistent pain (~10% in both groups).
- Pedobarography indicated improved fore-aft loading and normalized medial-lateral distribution in both cohorts.
Conclusions:
- Calcaneal lengthening osteotomy provides durable radiographic correction and acceptable clinical results in children with CP.
- Surgical timing before or after 8 years of age does not adversely affect long-term recurrence, revision rates, or pain.
- Age at surgery is not a significant factor in the long-term success of CLO for pediatric CP foot reconstruction.
Background:
The optimal age for calcaneal lengthening osteotomy in children with cerebral palsy remains controversial. Younger age has been suggested as a risk factor for recurrence or overcorrection, but long-term clinical data are limited. The primary purpose of this study was to determine whether age at surgery influences long-term radiographic maintenance of correction and clinical outcomes.
Methods:
A retrospective review was performed of 102 patients (155 feet) with cerebral palsy who underwent lateral column lengthening as part of a foot reconstruction procedure between 1990 and 2020 with a minimum of 5 years of radiographic follow-up. Patients were divided into 2 cohorts based on age at surgery: younger than or equal to 8 years (55 patients, 85 feet) and older than 8 years (47 patients, 70 feet). Radiographic parameters were measured preoperatively and at the latest follow-up. Longitudinal changes were assessed using mixed-effects modeling. Secondary outcomes included revision surgery, persistent pain, and pedobarographic analysis in a subset of patients.
Results:
Both cohorts showed significant improvement in nearly all radiographic parameters postoperatively (P<0.05), with no differences between groups at long-term follow-up. Mixed-effects modeling demonstrated gradual changes in several radiographic measures over time; however, rates of change were similar between cohorts. Revision surgery was performed in 11.8% of feet in the younger cohort and 7.1% in the older cohort (P>0.05). Overcorrection requiring revision occurred in 2 feet, both in the younger cohort. Persistent pain was reported in ~10% of patients in both groups. Pedobarographic analysis demonstrated improvement in fore-aft loading and directionally more normalized loading in the medial-lateral distribution in both cohorts, although medial-lateral changes were not statistically significant.
Conclusions:
Foot reconstruction involving calcaneal lengthening osteotomy provides radiographic correction and acceptable clinical outcomes in children with cerebral palsy, regardless of whether surgery is performed before or after 8 years of age. Age at surgery was not associated with increased recurrence, revision, or persistent pain at long-term follow-up.
Level Of Evidence:
Level III-retrospective comparative study.
