- Discussion:
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pattern of cerebral palsy influences type of foot & ankle deformities;
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ankle equinus:
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equinovarus:
-
pes valgus:
- equinovalgus deformity:
- is more common in children w/ diplegia and spastic quadriplegia;
- in ambulatory children, mild deformity can be corrected w/ peroneal tendon lengthening (transfer
of brevis to posterior tibialis is unreliable) combined w/ achilles tendon lengthening;
- if heel valgus is pronouned, medial displacement os calcis osteotomy can be added;
- if heel valgus and forefoot pronation are marked, opening wedge osteotomy of the anterior calcaneal process can be performed;
- if hindfoot is in rigid valgus, it is best to combine an extra-articlar subtalar fusion with the tendon lengthening;
- more common in spastic diplegia;
- caused by spastic peroneals, contracted heel cords;
- peroneus brevis lengthening is helpful to correct moderate valgus;
- subtalar arthrodesis is reserved for severe valgus deformities;
-
diff dx: toe walking
Chronologic outcome of surgical tendoachilles lengthening and natural history of gastroc-soleus contracture in cerebral palsy. A two-part study.
A Prospective Study of Inhibitive Casting as an Adjunct to Physiotherapy for Cerebral-Palsied Children.
Watt, Joe et al.
Devel. Med. and Child Neurol., 28: 480-488, 1986.
Equilibrium reactions in the feet of children with spastic cerebral palsy and of normal children.
Gunsolus P, Welsh C, Houser CE:
Dev Med Child Neurol 1975;17:580-591.
Surgical correction of equinus deformity in cerebral palsy.
CL Lee and EE Bleck.
Dev. Med. Child. Neurol. Vol 22. 1980. p 287-292.
