Atlas of Foot and Ankle Procedures in Cerebral Palsy

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.