Approach to bone procedure in fixed equinovarus deformity in cerebral palsy

Abstract

Fixed equinovarus deformity in cerebral palsy requires bone procedures for surgical correction. We reported the outcome of surgical procedure establishing the approach to multiple osteotomy and fusion to this problem. Retrospectively, 55 feet were reviewed. Step of surgical evaluation were applied to all patients by addressing each component of equinovarus deformity. 31 feet achieved correction by multiple osteotomy. Overall 78% had good outcome and maintained plantigrade foot. This study had outlined a simple surgical step-approached procedure to address fixed equinovarus deformity in cerebral palsy with high success rates. We recommended multiple bone osteotomy to preserve joint motion.

Keywords: Cerebral palsy; Fixed equinovarus; Foot arthrodesis; Foot deformity; Foot osteotomy.

Fig. 1

Illustration depict the step surgical approach to fixed equinovarus deformity in cerebral palsy.

Fig. 2

The above pictures showed a 7-year old girl with left hemiplegic cerebral palsy. Fig. 2A: Pre-operative pictures showed fixed left equinovarus deformity. Fig. 2B: 7 years after surgery. The left foot was plantigrade with no recurrent deformity. She received calcaneal closed wedge and 1st metatarsal closed wedge osteotomy, split anterior tibialis tendon transfer and tendo-Achilles recession. Fig. 2C: Anteroposterior and lateral radiograph films for calcaneal osteotomy and 1st metatarsal osteotomy with K-wire in-situ.