What are the long-term outcomes of lateral column lengthening for pes planovalgus in cerebral palsy?

Abstract

Background: Lateral column lengthening (LCL) is commonly performed on children and adolescents with cerebral palsy (CP) for correction of pes planovalgus (PPV). There are limited reports of the long-term outcomes of this procedure. The purpose of this study was to examine the long-term results of LCL for correction of PPV in individuals with CP by evaluating subjects when they had transitioned to adulthood and were entering the workforce.

Methods: Clinical assessments, quantitative gait analysis including the Milwaukee Foot Model (MFM) for segmental foot kinematics, and patient reported outcomes were collected from 13 participants with CP treated with LCL for PPV in childhood (average age 24.4 ± 5.7 years, average 15.3 ± 8.5 years since LCL). Additionally, 27 healthy adults average age 24.5 ± 3.6 years functioned as controls.

Results: Strength and joint range of motion were reduced in the PPV group (p < 0.05). Sixty nine percent showed operative correction of PPV based on radiologic criteria. Gait analysis showed reduced walking speed and stride length, as well as midfoot break and residual forefoot abduction. Patient reported outcomes indicated that foot pain was not the only factor that caused limited activity and participation. LCL surgery for PPV in childhood resulted in long-term operative correction. Decreased ankle passive range of motion and strength, subtalar joint arthritic changes, inefficient and less stable ambulation, and problems with participation (difficulties in physical function, education, and employment) were observed in the long-term.

Conclusion: This study identified postoperative impairments and limitations to guide future clinical decision-making. These results provide clinicians and researchers the common residual and recurrent issues for these individuals as they age. The inclusion of contextual factors that influence the disease and impairments can equip these individuals with enhanced skills they need as they transition into adulthood.

Keywords: Biomechanics; Calcaneal lengthening; Cerebral palsy; Pes planovalgus.

Fig. 1

Example lateral radiograph of participant in LCL Group showing subtalar arthritis.

Fig. 2

Kinematics for pelvis, hip, knee, and ankle during walking. The grey band shows normalized averages of the Control Group while the red lines show averages and S.D.s of the PPV Group. Heat maps below each plot represent the period of the gait cycle where significant differences were identified (p < adjusted α, darker colors indicate greater difference).

Fig. 3

Segmental foot kinematics for tibia, hindfoot, and forefoot during walking. The grey band shows normalized averages of the Control Group while the red lines show averages and S.D.s of the PPV Group. Heat maps below each plot represent the period of the gait cycle where significant differences were identified (p < adjusted α, darker colors indicate greater difference).