Outcome of surgical management of plano-valgus foot in cerebral palsy with batchelor’s extra-articular subtalar arthrodesis
Journal Title: Indian Journal of Orthopaedics Surgery - Year 2018, Vol 4, Issue 1
Abstract
Introduction Foot deformities caused by altered or abnormal muscle forces are common in patients with cerebral palsy The incidence of foot deformities in cerebral palsy is approximately 70 to 90 The most common deformity is ankle equinus with equinovarus and equinovalgus deformities being equally common A foot deformity can have significant effects on the patients overall ambulatory level The purpose of this study was to assess the functional outcome of batchelorrsquos extraarticular subtalar arthrodesis in spastic planovalgus foot in cerebral palsy childrenMaterials and Methods This is a prospective study of 40 patients 68 feet with spastic planovalgus foot deformity presenting to BIRRD T Hospital from October 2015 to October 2017 Children with spastic planovalgus foot between 6 yrs14 yrs were included in study There were 24 male and 16 female children The mean age at the time of surgery was 10 yrs Both feet were involved in 28 children 8 had right foot involvement and 4 had left foot involvement In our study we had 12 hemiplegics and 28 diplegics Children with mental retardation extra pyramidal type of cerebral palsy rigid planovalgus foot spastic quadriplegia were excluded from the study All patients underwent batchelorrsquos arthrodesis with fibular graft and were immobilized in below knee POP cast for 8 weeks 24 patients underwent gastrosoleus lengthening along with batchelorrsquos arthrodesis Clinical and functional outcome was assessed based on AOFAS American orthopaedic foot and ankle score clinical rating system Radiological assessment was done by measuring Lateral talocalcaneal angle and Talar declination angle The results of batchelorrsquos arthrodesis are stated as satisfactory and unsatisfactorySatisfactory Clinical and roentgenographic stabilization of the hind foot and no recurrence of planovalgus deformity Unsatisfactory Clinical and roentogenographic evidence of failure of stabilizationResults and Discussion All children had spastic type of cerebral palsy Postoperatively children were followedup for an average period of 14 months with range from 4 to 24 months Among 40 patients 68 feet 8 feet 12 percent had residual valgus 12 feet 18 percent had graft absorption 4 feet 6 percent had fracture of the graft and none had varus deformity after an average followup of 14 months Out of 68 feet 44 feet had ldquosatisfactoryrdquo result 65 percent and 24 feet had ldquounsatisfactoryrdquo result 35 percentConclusion Our experience concludes that batchelorrsquos extraarticular arthrodesis of subtalar joint is a good procedure for correction of planovalgus foot deformity in cerebral palsy patients Advantages of the procedure are simplicity of the technique immediate firm fixation and early weight bearingKeywords Cerebral palsy Batchelorrsquos subtalar arthrodesis Planovalgus foot AOFAS clinical rating system
Authors and Affiliations
G. Jagadesh, T. Naveen Babu, S. M. Venugopal, G. Karthik, K. Pavan Kumar Yadav
Keywords
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- EP ID EP476582
- DOI 10.18231/2395-1362.2018.0013
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