Local and distant effects of isolated calf muscle lengthening in children with cerebral palsy and equinus gait

Abstract

Purpose The purpose was to assess the local and distant effects of isolated calf muscle lengthening in ambulant children with cerebral palsy. Methods The study included fifteen ambulant children with cerebral palsy (nine with diplegia and six with hemiplegia), average age 8.8 years, Gross Motor Function Classification System (GMFCS) level I and II. None of the children had previously undergone orthopaedic surgery, apart from one child who had tendo-achilles lengthening (TAL) nine years earlier. All the children underwent pre and post-operative clinical examination and three-dimensional gait analysis (gait analysis). Twenty calf muscle lengthenings were performed, ten TAL and ten gastrocnemius recessions (GR). Results Post-operative ankle kinematics showed significant improvements in all parameters. Ankle power during push-off increased, but only significantly after TAL. Only one limb (5%) was over-corrected. Four limbs (20%) were under-corrected and one of these limbs remained in mild equinus position in stance. There was one recurrent equinus (5%) during the follow-up period of three years (range: 13-55 months). Distant effects on joints and segments were more marked in diplegia than in hemiplegia. Ten of 17 kinematic parameters distant from the ankle joint improved significant post-operatively when the preoperative values were 1SD below or above the mean of the normal material. There was no significant deterioration in any of the measured parameters. Conclusion The improvement in ankle kinematics and kinetics supported the experience of other studies. The distant effects, which have previously not been evaluated in three planes, showed improvement in several kinematic parameters indicating that additional surgery in selected patients could be abandoned or delayed.

Surgical correction of equinus deformity in children with cerebral palsy: A systematic review

“…Calcaneus deformity, calcaneus gait and crouch gait by topographical distribution Nine of the 35 studies reported explicit criteria for calcaneal gait, calcaneal deformity or crouch gait [2,17,19,20,22,27,38,39,44]. These definitions included the inability to passively plantarflex the foot to neutral, greater than 14°T of ankle dorsiflexion in stance or 10°of ankle dorsiflexion greater than the normal, as a definition of calcaneus deformity and the need for a floor reaction orthosis for crouch gait.…”

Long Term Follow-up of Subcutaneous Achilles Tendon Lengthening in the Treatment of Spastic Equinus Foot in Patients with Cerebral Palsy

“…oraz Chang'a II Park'a i wsp. po twier dzi ły po pra wę ki ne ty ki oraz ki ne ma tyki sta wu sko ko we go po wy ko na niu wy dłu że nia ścię -gna Achil le sa [16,17]. Brak na to miast w opu bli ko wanych ba da niach pró by wy ja śnie nia przy czy ny stop niowe go na ra sta nia wraz z wie kiem ilo ści na wro tów u pa cjen tów ope ro wa nych po 8 ro ku ży cia.…”

“…To enable a more accurate determination of the risk of recurrence, the patients were divided into two groups according to whether they had been operated before or after reaching the age of 8 years. Group I, those operated before the age of 8 years, ni okres ob ser wa cji w gru pie I wy niósł 9,77 lat (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17), na to miast w gru pie II śred ni okres ob ser wa cji wy niósł 10,76 lat (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

“…Bjorn Lofterod et al and Chang II Park et al found improvements in ankle kinetics and kinematics following Achilles tendon lengthening [16,17]. The available papers did not attempt to explain the cause of the recurrence rate gradually increasing with time in patients operated over the age of 8 years.…”

Effects of simulated crouch gait on foot kinematics and kinetics in healthy children

“…Most of the studies on foot deformities in children with CP focused on local and more proximal effects of isolated surgical correction of equinus foot deformity [9][10][11][12]. The results of these studies showed that, although after correcting an equinus deformity ankle kinematics were significantly improved, the surgical correction had a smaller and more variable effect on more proximal joints like the knee.…”