Advertisement

Atlas of Foot and Ankle Procedures in Cerebral Palsy

  • Freeman MillerEmail author
Living reference work entry

Abstract

Correction of foot deformities in children with cerebral palsy (CP) is one of the most common operative procedures performed on the musculoskeletal system. Many young children have equinus deformities, and as they grow the foot may develop a planovalgus deformity or an equinovarus deformity. Many of these feet are associated with bunions and toe deformities as well. The initial treatments for deformities of the feet are adequate orthotic control and physical therapy to enhance motor control and muscle strengthening. As the child gets older and no longer tolerates the orthosis or has a goal of moving beyond using orthosis, surgical correction can be considered. Correction of the foot deformities are usually in coordination with other lower extremity surgeries. Single-event multilevel surgery (SEMLS) is the standard of care and currently requires a detailed investigation to identify all of the contributing deformities. Frequently in coordination with the correction of foot deformities, there is a need to correct deformities at the knee and/or the hips. The focus of this current chapter will be on describing in detail the indications for correction of each individual deformity including technical details on the surgical correction and the postoperative management. This is with the understanding that this often is done in coordination with other procedures following evaluation with three-dimensional gait analysis.

Keywords

Cerebral palsy Subtalar fusion Achilles lengthening Gastrocnemius lengthening Tibialis posterior transfer Tibialis anterior transfer Medial column correction Bunion correction Ingrown toenail Claw toe Hammer toe 

References

  1. Andreacchio A, Orellana CA, Miller F, Bowen TR (2000) Lateral column lengthening as treatment for planovalgus foot deformity in ambulatory children with spastic cerebral palsy. J Pediatr Orthop 20:501–505PubMedGoogle Scholar
  2. Chang CH, Albarracin JP, Lipton GE, Miller F (2002) Long-term follow-up of surgery for equinovarus foot deformity in children with cerebral palsy. J Pediatr Orthop 22:792–799PubMedGoogle Scholar
  3. Chen L, Greisberg J (2009) Achilles lengthening procedures. Foot Ankle Clin 14:627–637CrossRefGoogle Scholar
  4. de Moraes Barros Fucs PM, Svartman C, de Assumpcao RM, Yamada HH, Simis SD (2012) Surgical technique: medial column arthrodesis in rigid spastic planovalgus feet. Clin Orthop Relat Res 470:1334–1343CrossRefGoogle Scholar
  5. Ettl V, Wollmerstedt N, Kirschner S, Morrison R, Pasold E, Raab P (2009) Calcaneal lengthening for planovalgus deformity in children with cerebral palsy. Foot Ankle Int 30:398–404CrossRefGoogle Scholar
  6. Hoiness PR, Capjon H, Lofterod B (2014) Pain and rehabilitation problems after single-event multilevel surgery including bony foot surgery in cerebral palsy. A series of 7 children. Acta Orthop 85:646–651CrossRefGoogle Scholar
  7. Jenter M, Lipton GE, Miller F (1998) Operative treatment for hallux valgus in children with cerebral palsy. Foot Ankle Int 19:830–835CrossRefGoogle Scholar
  8. Kadhim M, Miller F (2014) Pes planovalgus deformity in children with cerebral palsy: review article. J Pediatr Orthop B 23:400–405CrossRefGoogle Scholar
  9. Kadhim M, Holmes L Jr, Church C, Henley J, Miller F (2012) Pes planovalgus deformity surgical correction in ambulatory children with cerebral palsy. J Child Orthop 6:217–227CrossRefGoogle Scholar
  10. Karamitopoulos MS, Nirenstein L (2015) Neuromuscular foot: spastic cerebral palsy. Foot Ankle Clin 20:657–668CrossRefGoogle Scholar
  11. Lamberts RP, Burger M, du Toit J, Langerak NG (2016) A systematic review of the effects of single-event multilevel surgery on gait parameters in children with spastic cerebral palsy. PLoS One 11:e0164686CrossRefGoogle Scholar
  12. Noritake K, Yoshihashi Y, Miyata T (2005) Calcaneal lengthening for planovalgus foot deformity in children with spastic cerebral palsy. J Pediatr Orthop B 14:274–279CrossRefGoogle Scholar
  13. O'Byrne JM, Kennedy A, Jenkinson A, O'Brien TM (1997) Split tibialis posterior tendon transfer in the treatment of spastic equinovarus foot. J Pediatr Orthop 17:481–485PubMedGoogle Scholar
  14. Sees JP, Miller F (2013) Overview of foot deformity management in children with cerebral palsy. J Child Orthop 7:373–377CrossRefGoogle Scholar
  15. Sung KH, Chung CY, Lee KM, Akhmedov B, Lee SY, Choi IH, Cho TJ, Yoo WJ, Park MS (2013a) Long term outcome of single event multilevel surgery in spastic diplegia with flexed knee gait. Gait Posture 37:536–541CrossRefGoogle Scholar
  16. Sung KH, Chung CY, Lee KM, Lee SY, Park MS (2013b) Calcaneal lengthening for planovalgus foot deformity in patients with cerebral palsy. Clin Orthop Relat Res 471:1682–1690CrossRefGoogle Scholar
  17. Tinney A, Khot A, Eizenberg N, Wolfe R, Graham HK (2014) Gastrocsoleus recession techniques: an anatomical and biomechanical study in human cadavers. Bone Joint J 96-B:778–782CrossRefGoogle Scholar
  18. Tinney A, Thomason P, Sangeux M, Khot A, Graham HK (2015) The transverse Vulpius gastrocsoleus recession for equinus gait in children with cerebral palsy. Bone Joint J 97-B:564–571CrossRefGoogle Scholar
  19. Vlachou M, Beris A, Dimitriadis D (2010) Split tibialis posterior tendon transfer for correction of spastic equinovarus hindfoot deformity. Acta Orthop Belg 76:651–657PubMedGoogle Scholar
  20. Yngve DA, Chambers C (1996) Vulpius and Z-lengthening. J Pediatr Orthop 16:759–764CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

Section editors and affiliations

  • Freeman Miller
    • 1
  1. 1.Nemours Alfred I. duPont Hospital for ChildrenWilmingtonUSA

Personalised recommendations