Overview of foot deformity management in children with cerebral palsy

Abstract

Foot deformities in children with cerebral palsy are common. The natural history of the deformities of the feet is very variable and very unpredictable in young children less then 5 years old. Treatment for the young children should be primarily with orthotics and manual therapy. Equinus is the most common deformity, with orthotics augmented with botulinum toxin being the primary management in young children. When fixed deformity develops lengthening only the muscle which is contracted is preferred. Varus deformity of the feet is often associated with equinus, and can almost always be managed with orthotics until 8 or 10 years of age. Planovalgus is the most common deformity in children with bilateral lower extremity spasticity. The primary management is orthotics until the child no longer tolerates the orthotic; then surgical management needs to consider all the deformities and all should be corrected. This requires correcting the subtalor subluxation with calcaneal lengthening or fusion, medial midfoot correction with osteotomy or fusion.

Changes in the kinematic parameters of gait in children with cerebral palsy after multilevel interventions with the initial patterns of true equinus gait and jump gait

“…In muscle retraction accompanied by critical deterioration of goniometric parameters, surgical orthopedic treatment becomes reasonable [38][39][40]. However, in addition to muscle retraction, the objects of surgical treatment in multilevel interventions for these types of gait are foot deformities and torsion of segments [41][42][43][44][45][46][47][48][49][50][51].…”

The role of neurogenic feet deformities in the lower limb dysfunction structure in patients with cerebral palsy. Management of surgical treatment. Literature data review

“…По данным Julieanne P. Sees и Freeman Miller, у детей в возрасте до 8 лет при полной транспозиции сухожилия передней большеберцовой мышцы отмечается крайне высокий риск трансформации деформации в плосковальгусную. Учитывая это, детям до 8 лет целесообразно выполнять частичную транспозицию сухожилия передней большеберцовой мышцы [38].…”

Orthopedic surgery in cerebral palsy: Instructional course lecture

“…The surgical lengthening of muscle tendon unit should specifically focus only on the contracted muscle, in diplegia typically only the gastrocnemius, with a mid calf myofascial release. In hemiplegia, the soleus also sometimes develops contractures and a combined slightly more distal myofascial release of the conjoined tendon is preferred 96. It must be emphasized that it is preferable to have several recurrent equinus contractures than to have one overcorrection.…”