Prospective Comparison of Subtalar Arthroereisis With Calcaneal Lengthening in the Management of Planovalgus Feet of Ambulatory Children With Spastic Cerebral Palsy?

Abstract

Background

Pes planovalgus (PPV) deformity is common among cerebral palsy (CP) patients. There is no true consensus about the best way of treating this common deformity, especially when surgical interference is required. Treatment options range from orthotics to complex surgical procedures. The purpose of this prospective study was to evaluate and compare the effectiveness of 2 different procedures in the correction of symptomatic flexible PPV in ambulatory CP patients.

Methods

A total of 57 feet in 35 patients were divided into 2 groups: group 1, subtalar arthroereisis group, using the calcaneostop technique; group 2, lateral column lengthening group, using Evans osteotomy. Patients were assessed clinically by the clinical score proposed by Yoo et al and radiologically by measuring 7 weight-bearing angles, both preoperatively and 12 months postoperatively. Patients’ (or parents’) satisfaction and their tolerance to braces or shoes were assessed 12 months after surgery as secondary outcome parameters.

Results

There was a statistically significant improvement in both primary and secondary outcome parameters after both procedures in comparison to the preoperative parameters. No statistically significant differences were observed between the 2 groups regarding the outcomes of both procedures except for the greater power of arthroereisis in the correction of hindfoot valgus, which was statistically significant both clinically and radiographically.

Conclusion

Both procedures are valid options for the surgical management of PPV in ambulatory children with spastic CP. The less-invasive nature and lower potential morbidity suggest that judicious use of arthroereisis is appropriate for some patients, especially in the context of single-event multilevel surgery.

Levels of Evidence:

Level II: Prospective, comparative study.