Management of Severe Equinovalgus in Patients With Cerebral Palsy by Naviculectomy in Combination With Midfoot Arthrodesis

Journal article


Publication Details

Author(s): Dussa C, Doederlein L, Forst R, Boehm H, Fujak A
Journal: Foot & Ankle International
Publication year: 2017
Volume: 38
Journal issue: 9
Pages range: 1011-1019
ISSN: 1071-1007


Abstract

BACKGROUND: Equinovalgus deformity is the second most common deformity in cerebral palsy and may be flexible or rigid. Several operative methods from joint sparing to arthrodesis have been described with varying success rates. The aim of this study was to investigate the effectiveness of naviculectomy in combination with midfoot arthrodesis (talo-cuneiform and calcaneocuboid arthrodesis) in the correction of a rigid equinovalgus foot deformity in cerebral palsy.
METHODS: Forty-eight rigid equinovalgus feet were operated upon in 30 patients from 2008 to 2013. Of these, 44 feet in 26 patients with cerebral palsy (Gross Motor Function Classification System III, IV, or V) with follow-up of more than 2 years were included in the study. The mean age at surgery was 18.1 years. The outcomes were measured objectively using radiographic angles and subjectively using 5 questions to be answered by the caregiver. The feet were then graded into excellent, good, fair, and poor. The mean follow-up was 5.0 ± 1.7 years.
RESULTS: Excellent to good results were obtained in 81% of the feet. Both objective and subjective outcomes improved significantly postoperatively ( P < .001). Three feet in 2 patients were graded as poor and underwent a revision operation for pain and recurrence.
CONCLUSIONS: Naviculectomy in combination with midfoot arthrodesis enabled a good 3-dimensional correction of the forefoot. However, the procedure did not necessarily correct the fixed subtalar joint deformity. Several additional bony and soft-tissue procedures were necessary to achieve a complete correction in these difficult feet.
LEVEL OF EVIDENCE: Level IV, retrospective case series.


FAU Authors / FAU Editors

Dussa, Chakravarthy
Lehrstuhl für Orthopädie mit Orthopädischer Chirurgie
Forst, Raimund Prof. Dr. med.
Lehrstuhl für Orthopädie mit Orthopädischer Chirurgie


External institutions
Behandlungszentrum Aschau GmbH


How to cite

APA:
Dussa, C., Doederlein, L., Forst, R., Boehm, H., & Fujak, A. (2017). Management of Severe Equinovalgus in Patients With Cerebral Palsy by Naviculectomy in Combination With Midfoot Arthrodesis. Foot & Ankle International, 38(9), 1011-1019. https://dx.doi.org/10.1177/1071100717709577

MLA:
Dussa, Chakravarthy, et al. "Management of Severe Equinovalgus in Patients With Cerebral Palsy by Naviculectomy in Combination With Midfoot Arthrodesis." Foot & Ankle International 38.9 (2017): 1011-1019.

BibTeX: 

Last updated on 2018-12-11 at 13:23