Surgical correction of flexible planovalgus feet in children and adolescents with neuromuscular disorders

Abstract

Planovalgus foot is a common deformity in childhood and adolescents. In the normal population it has a relatively benign self-limiting natural history. However, in patients with neuromuscular disorders the prognosis is different. Planovalgus is the most common foot deformity in cerebral palsy patients, in particular in patients with diplegia and quadriplegia. As the child grows the deformity is usually progressive, with problems ranging from gait dysfunction to foot pain and difficulty in bracing or shoe fitting. Bracing and conservative treatment are tried, when they fail, surgery is recommended. Numerous surgical procedures were described and no one proved superior. Options include extra-articular subtalar arthrodesis, intra-articular subtalar arthrodesis, arthroereisis, and foot osteotomies. The combination calcanealcuboid- cuneiform osteotomies, known as Triple C was described in 1998. It was suggested that it provides adequate correction even in the more severe deformities.