Gulzar Saeed Ahmed, Bilal Fazal Shaikh, Abdul Rauf Memon.
Surgical treatment of equinovarus deformity of foot in children with cerebral palsy.
Med Channel Jan ;17(3):21-4.
Introduction:Foot deformities e.g., ankle equinus, equinovarus and equinovalgus, are common in patients with CP. Varus deformity which is usually accompanied by equinus, is commonly caused by an abnormal posterior tibial muscle,anterior tibial muscle or both. If left untreated, may cause severe fixed foot deformity .Various methods of treatment have been reported. Material and Method:Twenty patients (25 feet) were included in this study.The patients were assessed clinically and patients with forefoot varus and aquinus were treated by split transfer of tibialis anterior to the cuboid and patients with hind foot varus and equinus were treated by split transfer of tibialis posterior tendon through interosseous membrane, to the lateral cuniform. Percutaneus lengthening of tendocalcaneus was performed in all patients. The outcome was analyzed. Results:The age range at the start of study was between six to ten years (mean 8years.), and at the last follow up was eight to fourteen years (mean 11.5 years). Mean follow-up was 3.5 years.The range of varus deformity was 15 0to 200 and range of equinus was between 160 to 250. Split transfer of tibialis anterior tendon was performed in seven patients (8feet) presenting with fore foot varus and equinus. Split transfer of tibialis posterior tendon was performed in thirteen patients (17 feet) presenting with hind foot varus and equinus. Percutaneustendocalcaneuas lengthening was done in all cases. Open release of planter fascia was performed in fourteen feet as there was mild cavus deformity. The results were graded according to Kling’s clinical criteria. The results were excellent in fourteen feet, good in 7 feet, and poor in four feet. Poor results were seen in four of our patients with marked tendocalcaneus shortening, as the deforming force was not successfully determined clinically in these cases. Most of our patients had excellent results. Conclusion: split tibialis anterior tendon transfer to cuboid in patients with forefoot varus and split tibialis posterior tendon transfer through interosseous membrane to lateral cuniform in patients with hind foot varus, are good and rewarding procedures. However accurate diagnosis of deforming muscle i.e, tibialis anterior or tibialis posterior is essential to produce good results.
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