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.

Keywords: Cerebral palsy; Equinovarus; Equinus; Planovalgus feet.

Fig. 1

Example of a 16-year-old boy with asymmetric diplegia with an equinovalgus foot on the left. The weight-bearing photograph shows severe hindfoot valgus with medial forefoot weight-bearing (a), the pedobarograph shows a similar weight-bearing pattern (b), while the lateral radiograph shows a midfoot break (c), and the AP radiograph shows a bunion and uncovering of the head of the talus (d). One year after surgery, the hindfoot is well corrected (e), as confirmed by the pedobarograph (f). The lateral radiograph shows excellent correction of the subtalar and medial cuneiform–navicular fusion (g), and good correction is seen in the AP plane with the addition of the Aiken bunion correction (h)