Correction of Pes Planovalgus in Cerebral Palsy: A Short Term Outcome of Extra-articular Subtalar Arthrodesis

Abstract

Pes planovalgus is the most common foot deformity observed in cerebral palsy (CP) patients which is characterized by a loss of the medial longitudinal arch and malalignment of the foot; hindfoot valgus and forefoot abduction which could progress with time causing pain or brace intolerance that occur secondary to pressure medially over the prominent talar head. The treatment of this deformity should be directed to correct the foot malalignment, secure the stability of the foot during stance and correct the abnormal gait. Muscle imbalance, spasticity and tightness of the calf and peroneal muscles are the main causes for this deformity. The aim of the treatment is to obtain a foot with normal alignment which exhibits no pain and preventing the degenerative changes that may take place in the future. Surgical options should be offered to patients when conservative treatment failed, prior to development of permanent contractures and structural osseous changes. Numerous surgical procedures were described varies from simple soft tissue procedures (tendo-achillis lengthening, tendon transfers, etc.) to tarsal osteotomies, subtalar extra-articular arthrodesis, intra-articular arthrodesis and triple arthrodesis. When these are compared, all techniques have advantages and disadvantages. This study was conducted to evaluate the short term outcome of the extra-articular subtalar arthrodesis using fibular graft that harvested from the junction between the proximal 1/3 and the distal 2/3 of the fibula in correction of flexible pes planovalgus in children with cerebral palsy.