Treatment of spastic varus/ equinovarus foot with split-tendon transfers in cerebral palsy: How does it affect the hindfoot motion? |
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| Institution: | 1. Department of Paediatric Orthopaedics, Orthopaedische Kinderklinik, Bernauerstrasse 18, D-83229 Aschau i. Chiemgau, Bavaria, Germany;2. Gait Laboratory, Orthopaedische Kinderklinik, Bernauerstrasse 18, D-83229 Aschau i. Chiemgau, Bavaria, Germany;3. Pediatric Orthopaedic Surgeon, Aukamm Klinik, Leibnizstraße 21, 65191 Wiesbaden, Germany;4. Department of Trauma and Orthopaedic Surgery, Pediatric and Neuro Orthopaedics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, D-91054 Erlangen, Bavaria, Germany;1. Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA;2. Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA;1. Shanghai University of Sport, School of Physical Education and Sport Training, Shanghai, China;2. Suzhou Early Childhood Education College, Suzhou, Jiangsu Province, China;3. Huangqiao Central Kindergarten, Suzhou, Jiangsu Province, China;4. Department of Physical Education, Sanda University, Shanghai, China;5. Shanghai Research Center for Physical Fitness and Health of Children and Adolescents, Shanghai, China;1. Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA;2. Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA;3. Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA;4. Biomechanics Research Institute, Vector Bio, Inc., Seoul, South Korea;1. University Bonn, Institute of Finance and Statistics, Adenauerallee 24-26, 53113 Bonn, Germany;2. Hausdorff Center for Mathematics, Bonn, Germany |
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| Abstract: | IntroductionThe flexible spastic varus foot in cerebral palsy is commonly corrected by split-tendon transfer of tibialis anterior or tibialis posterior. These tendon transfers are said to preserve hindfoot motion, which is until now not been proven. Therefore, the aim of the study was to show the hindfoot motion following split-tendon transfer in comparison to a midtarsal arthrodesis.Materials and methodsA retrospective study was done on patients with flexible spastic varus foot in cerebral palsy who underwent a combined split-tendon transfer of tibialis anterior and posterior. Patients with a rigid foot deformity underwent a midfoot arthrodesis. These children and normal children served as controls. An instrumented gait analysis was done in all patients before and at follow-up. A statistical analysis was done using 2-factor ANOVA with repeated measures on time.ResultsThirteen children underwent a combined split-tendon transfers of tibialis anterior and posterior muscles and 14 children midtarsal arthrodesis. The mean follow-up was 2.4 (SD=0.8) years for flexible varus foot and 1.9 (SD=0.7) years for rigid foot deformity. The preoperative hindfoot range of motion in eversion-inversion was 54% and 49% of TD controls in flexible varus foot and rigid foot deformity respectively. At follow-up, it reduced further to 45% and 42% of TD controls in the respective groups.ConclusionBoth flexible and rigid hindfoot deformity reduced the hindfoot motion. However following surgery, the hindfoot motion reduced further and was identical in both groups independent of the type of surgery. This indicates a tenodesis-effect of split-tendon transfers on the hindfoot. |
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| Keywords: | Cerebral palsy Spastic varus/equinovarus foot Split-tendon transfers SPLATT SPOTT Tibialis anterior Tibialis posterior Midtarsal arthrodesis Chopart arthrodesis Hindfoot kinematics |
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