Ankle Valgus in Cerebral Palsy

Abstract

Valgus deformity of the ankle joint has been well recognized as part of the external rotation planovalgus collapse of the paralyzed foot most commonly seen in spina bifida. This same association has been reported in spastic planovalgus feet of children with cerebral palsy (CP), as an unrecognized contributor of hindfoot valgus. Also, there is a well-defined syndrome of increasing ankle valgus when a section of the fibula is resected for use as bone graft. Although the ankle valgus in spastic feet is not as profound as in the paralyzed foot of spina bifida, it is nevertheless significant in some children. The ankle valgus is rarely an isolated primary deformity in spastic feet, although it may be the primary deformity in rare children who are ambulatory with primary hypotonic CP. A common factor in ankle valgus in children with CP is that it is very often missed initially. Ankle valgus is a secondary deformity associated with planovalgus and external tibial torsion. The planovalgus may be appropriately treated but then when the patient still presents with what appears to be a valgus foot during stance phase of gait. The most important aspect of ankle valgus is recognizing when it is present. Treatment options include correction associated with a tibial osteotomy and medial malleolus screw epiphysiodesis. The goal of this chapter is to define the situations where ankle valgus is a problem, how to diagnose it, and the treatment options.