Anterior Transfer of the Long Toe Flexors for the Treatment of Spastic Equinovarus and Equinus Foot in Cerebral Palsy

Hiroshima, Kazuo; Hamada, Shigeyuki; Shimizu, Nobuyuki; Ohshita, Shunji; Ono, Katsuhiko

doi:10.1097/01241398-198803000-00008

Cited by 18 publications

(4 citation statements)

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“…Transfer of the FHL (and FDL) as a motor for dorsiflexion has been described by Hiroshima in pediatric cerebral palsy population (5). In contrast to above-described procedure, Hiroshima transferred FHL (and FDL in 62% of cases) to II metatarsal under the extensor retinaculum.…”

Section: Discussionmentioning

confidence: 99%

Flexor Hallucis Longus Transfer for Foot Drop without Functioning Tibialis Posterior

Boszczyk¹,

Kordasiewicz²

2017

Acta Chir. orthop. Traum. Cech.

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digitorum longus (EDL), peroneus longus (PL) and peroneus brevis (PB) revealed no function (MRC=0 (15)), while testing of FHL and FDL revealed full (MRC=5) strength. The TP was not functioning (MRC=0) with contracture limiting pronation beyond neutral. The gastrocnemius strength was 4 with contracture limiting dorsiflexion. Supination of the foot was unrestricted. The passive range of ankle motion was (0)-5-45° (equinus contracture of 5°). There was checkrein phenomenon of the toes at the limit of dorsiflexion. On x-ray there were no signs of arthritis in the hindfoot. Patient scored 74 and 71 points in FAOQ (2) and AOFAS (8) scales, respectively. Decision processWith no return of peroneal nerve function in two years observation, neither improvement in conduction studies despite neurolysis, the nerve injury was deemed irreparable. The patient was unwilling to accept the brace and he opted for operative treatment. With no voluntary contraction of TP this tendon was deemed unsuitable for transfer. Fibrotic degeneration of TP is visible in MRI (Fig. 1). With no functioning TP, two potential motors were available -FHL and FDL. We chose to transfer the FHL tendon to the dorsum of the foot. Operative technique and aftertreatmentThe patient was operated supine without a tourniquet (due to previous vascular reconstruction). Z-lengthening of the Achilles tendon was performed through stab incisions (18). By this maneuver 10 degrees of dorsiflexion was achieved. Dorsiflexion exacerbated the checkrein deformity of the toes. Medial approach to the midfoot

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Section: Discussionmentioning

confidence: 99%

Flexor Hallucis Longus Transfer for Foot Drop without Functioning Tibialis Posterior

Boszczyk¹,

Kordasiewicz²

2017

Acta Chir. orthop. Traum. Cech.

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“…The type of cerebral palsy was reported in thirteen studies, where one study reported a mixed CP type [41]. Twelve studies reported spastic CP [18,21,24,25,28,[30][31][32]35,[43][44][45], and one study reported athetoid CP [25]. The type of equinus was reported six studies, where one study reported static equinus [21] and five studies reported fixed equinus [18,26,[31][32][33].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…eight studies had a moderate risk of bias [19,29,30,33,34,39,43,46], and nine studies had serious risk of bias [8,[11][12][13]16,20,23,25,35]. The most common domain that had a serious risk of bias was confounding.…”

Section: Risk Of Biasmentioning

confidence: 99%

Recurrence of Equinus Foot in Cerebral Palsy following Its Correction—A Meta-Analysis

Horsch

Klotz²,

Platzer

et al. 2022

Children

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Background: Recurrence in cerebral palsy (CP) patients who have undergone operative or non-operative correction varies greatly from one study to another. Therefore, we conducted this meta-analysis to determine the pooled rate of equinus recurrence following its correction either surgically or non-surgically. Methods: Nine electronic databases were searched from inception to 6 May 2021, and the search was updated on 13 August 2021. We included all studies that reported the recurrence rate of equinus following its correction among CP patients. The primary outcome was recurrence, where data were reported as a pooled event (PE) rate and its corresponding 95% confidence interval (CI). We used the Cochrane’s risk of bias (RoB-II) tool and ROBINS-I tool to assess the quality of included randomized and non-randomized trials, respectively. We conducted subgroup analyses to identify the sources of heterogeneity. Results: The overall rate of recurrence was 0.15 (95% CI: 0.05–0.18; I2 = 88%; p < 0.01). Subgroup analyses indicated that the laterality of CP, study design, and intervention type were significant contributors to heterogeneity. The recurrence rate of equinus differed among interventions; it was highest in the multilevel surgery group (PE = 0.27; 95% CI: 0.19–0.38) and lowest in the Ilizarov procedure group (PE = 0.10; 95% CI: 0.04–0.24). Twelve studies had a low risk of bias, eight had a moderate risk, and nine had a serious risk of bias. Conclusion: The recurrence of equinus following its correction, either surgically or non-surgically, in CP patients is notably high. However, due to the poor quality of available evidence, our findings should be interpreted with caution. Future studies are still warranted to determine the actual risk of equinus recurrence in CP.

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“…29,30 Additionally, if tendon transfer is to be considered, the patient must be assessed for an equinus contracture. Transfer of other posterior muscles such as the flexor digitorum longus and flexor hallucis longus has been discussed and described.…”

Section: Tendon Transfersmentioning

confidence: 99%

Peroneal nerve palsy

Morris

Keenan

Baldwin

2015

Current Orthopaedic Practice

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Palsy of the peroneal or fibular nerve can be a devastating injury and is the most common mononeuropathy of the lower extremity. The clinical manifestations of peroneal neuropathy range from mild cutaneous symptoms to widespread sensory loss, pain, and foot drop, leading to ambulatory dysfunction. Injury to the nerve can be acute or chronic, and may result from intrinsic dysfunction or extrinsic manifestations. While most commonly injured at the knee, dysfunction may occur due to compression or injury of nerve fibers anywhere from the spine to the hip or ankle. This article reviews the anatomy of the peroneal nerve; the clinical findings, etiology, and evaluation of suspected peroneal nerve injury; and treatment options.

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Anterior Transfer of the Long Toe Flexors for the Treatment of Spastic Equinovarus and Equinus Foot in Cerebral Palsy

Cited by 18 publications

References 0 publications

Flexor Hallucis Longus Transfer for Foot Drop without Functioning Tibialis Posterior

Flexor Hallucis Longus Transfer for Foot Drop without Functioning Tibialis Posterior

Recurrence of Equinus Foot in Cerebral Palsy following Its Correction—A Meta-Analysis

Peroneal nerve palsy

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