Postoperative foot drop after gastrocsoleus lengthening in children with unilateral and bilateral cerebral palsy

Abstract

Background: Equinus foot is a frequent deformity in children with cerebral palsy (CP). After calf-muscle lengthening surgery, foot drop is frequent and seems to occur mainly in unilateral CP cases. It remains unclear if this complication can be prevented with same-procedure transfer or shortening of dorsiflexor tendons.

Methods: Retrospective analysis of 167 ambulant children with unilateral and bilateral CP, GMFCS levels I to III, who received surgical calf-muscle lengthening. Pre- and postoperative 3D instrumented gait analysis and clinical examination data were reviewed.

Results: Stance and swing phase dorsiflexion improved in both groups. Postoperative mean swing phase dorsiflexion was significantly lower in unilaterally affected than in bilaterally affected children (median -6° vs. +1°, P < .001). The incidence of postoperative foot drop in unilaterally and bilaterally affected patients was 50 % and 16 %, respectively, with a significant group difference (P < .001). Tendon transfers did not lead to a lower rate of postoperative foot drop, but were performed in children with more severe preoperative findings.

Conclusion: Children with unilateral CP are at a higher risk of postoperative foot drop after calf muscle lengthening than the bilaterally affected. Although the range of motion improved postoperatively, tendon transfers did not improve active dorsiflexion in children with unilateral CP and could thus not prevent foot drop effectively. Due to these findings, prospective research with preoperative assessment of tendon-muscle function is needed in this field.

Keywords: Achilles Tendon Lengthening; Cerebral palsy; Foot drop; Gait analysis.