الفهرس 
Epidemiology and Pathology of Flexible Pes PlanovalgusOnly 14 pages are availabe for public view
 |  | from | 151 |  |  |
| | | from | 151 | | |
Abstract
Introduction: 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.
Objectives: 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-achilles 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.
Patient and methods: Our population was 22 feet (13 patients) with cerebral palsy. The inclusion criteria were; ambulatory spastic CP patient up to grade 4 Gross Motor Function Classification System (GMFCS), Skeletally immature patients and symptomatic flexible pes planovalgus that failed conservative treatment for more than 6 months. The outcome was assessed clinically according to kim et al score which consist of evaluation of the improvement in pain, forefoot abduction, hindfoot valgus and the collapse of the foot medial longitudinal arch. Radiologically the outcome was assessed by comparing the preoperative and postoperative measures of the AP and lateral talocalcaneal angles, the AP and lateral talo-1st metatarsal angles and the calcaneal pitch angle.
Results: Clinically the results were satisfactory in 21 feet and unsatisfactory in 1 foot according to kim et al scoring system. Radiologically; the AP-TCA decreased from the median of 26⁰ (range 11⁰- 56⁰) preoperative to 9.5⁰ (range 1⁰ - 35⁰) postoperative. The lat. TCA deceased from the mean of 42.05⁰ ± 7.35⁰ preoperative to 28.82⁰ ± 8.61⁰ postoperative. This decrease indicates improvement of the heel valgus. The AP talo-1st MTS decrease from the median of 24⁰ (range 3⁰ - 55⁰) preoperative to 8⁰ (range 1- 39) postoperative that indicates improvement of the forefoot abduction. The Lat. talo-1st MTS decreased from the median of 20⁰ (range 3⁰ – 46⁰) preoperative to 8.5⁰ (range 0⁰ – 18⁰) postoperative and the calcanealpitch angle increased from the median of 5⁰ (range -16⁰ – 22⁰) preoperative to 10⁰ (range 2⁰ -17⁰) postoperative which indicate improvement of the medial longitudinal arch.
Conclusion: The extra-articular subtalar arthrodesis in our study as in others had been proved to be effective, safe, simple and non expensive procedure for correction of flexible pes planovalgus feet in children with cerebral palsy.