Szymon Pietrzak, Bartlomiej Grabowski, Jaroslaw Czubak Results of triple arthrodesis for equinovarus

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Szymon Pietrzak, Bartlomiej Grabowski, Jaroslaw
CzubakResults of triple arthrodesis for
equino-varus foot deformity in cerebral palsy
children and adolescents

• Department of Orthopaedics
• Postgraduate Medical Education Center Warsaw
• Prof. A. Gruca Teaching Hospital, Otwock, Poland

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Equinovarus deformity of the feet in cerebral
palsy (CP) children, caused by the primary
muscular imbalance, significantly impairs their
motor function. The triple arthrodesis of the
foot enables correction of more severe and rigid
deformities.
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Aim of the study

• Evaluation of results of triple arthrodesis
  performed in CP patients with equinovarus feet
  treated in our department between 1995 and 2004.

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Material

• Between 1995 and 2004 109 patients with spastic
  CP were operated because of foot deformities

• In 20 patients the triple arthrodesis of the
  foot was performed because of equino-varus
  deformity

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Surgery

• Triple arthrodesis
• Achilles tendon Z plasty in all feet
• tibialis posterior lengthening in 20 feet
• flexor hallucis longus lengthening in 1 foot
• tibialis anterior lengthening in 1 foot
• Fixation with K wires for 6 weeks
• Plaster cast 2 x 6 weeks
• None of the patients had any other surgical
  procedure in the follow-up

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Methods

• Clinical examination included data about
• pain
• function
• orthoses (if applied)
• positioning of the hindfoot and forefoot
• Radiographic assessment
• X rays in a-p and lateral views (for standing
  patients)

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Results

• None of the examined patients reported pain
  before the surgery,
• after 3 patients (3 feet) reported pain after
  long walking.
• Arthrosis was observed in 11 feet in the
  follow-up.
• There was no significant functional improvement
  after the surgery
• (the mean pre-op GMFCS score was 2.7, post op
  2.6).

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Results

• None of the walking patients used orthoses
  before the operation,
• after 4 patients used AFO durig the follow-up.
• Overcorrection (valgus of the hindfoot and
  abduction of the forefoot) was observed in 3 feet.

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Patient O.O. (F) operated at the age 11.4
GMFCS level II follow-up 4 yrs
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Conclusions

• Surgery did not significantly improve patients
• functional status during the follow-up. All of
  them
• reported a cosmetic improvement, the walking
• ones were satisfied with a better foot
  positioning
• during ambulation.
• There was no correlation with the functional
  score
• and the presence of arthrosis, although all these
• patients who reported pain had evident arthrosis
• on the X-rays.