The management of spastic deformities of the foot and ankle

The most common ankle and foot deformities in cerebral palsy are equinus, equinovalgus, equinovarus, calcaneus and hallux valgus. It makes little difference how the length of the triceps surae is re-established and how its stretch reflex is weakened as long as the patient is carefully chosen, the procedure done well and the postoperative regimen prolonged and detailed. The most common cause of failure is inadequate use of night support during growth to prevent recurrence. Significant equinovalgus has been successfully managed by heel cord lengthening and subtalar arthrodesis. The arthrodesis should not be performed unless the equinus has been corrected prior to or at the same time as the procedure to correct the valgus. Overcorrection must be avoided. Where equinovarus needs surgical correction and no bone deformity exists, heel cord and posterior tibial lengthening are successful. If there is significant bone deformity, a triple arthrodesis may also be necessary when growth is complete. The latter procedure should not be used to correct equinus for it ends up with a foot short in height, length and width.