Heel cord advancement has been advocated for treatment of spastic equinus deformity. Transferring the gastrosoleus anteriorly weakens it by changing the lever arm rather than the resting length. A retrospective review of 90 children with 122 limbs undergoing heel cord advancement revealed 11% excellent, 53% good, and 35% poor results (average follow-up 9.7 years). The results were statistically better in diplegics and community walkers. The better results in previous studies may be due to procedure modifications and shorter follow-up. Since we obtain comparable results with simpler heel cord lengthenings, we no longer do heel cord advancement.
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