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Changes in Dynamic Foot Pressure After Surgical Treatment of Valgus Deformity of the Hindfoot in Cerebral Palsy
Kun Bo Park, MD1; Hui Wan Park, MD2; Ki Seok Lee, MD2; Sun Young Joo, MD2; Hyun Woo Kim, MD2
1 Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang 431-070, South Korea
2 Department of Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, South Korea. E-mail address for H.W. Kim: pedhkim@yuhs.ac
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Aug 01;90(8):1712-1721. doi: 10.2106/JBJS.G.00792
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Abstract

Background: Calcaneal lengthening osteotomy and extra-articular arthrodesis of the subtalar joint are two methods used for the correction of valgus deformity of the heel and forefoot abduction. The purpose of this study was to compare the operative results of these procedures in patients with cerebral palsy who were able to walk. We focused primarily on changes in radiographic parameters and how altered mobility of the subtalar joint by the two operative methods would modify pressure distribution over the plantar surface of the foot.

Methods: A total of eighty-one feet in forty-seven patients were included in the study. The mean age at the time of surgery was eight years and one month, and the mean follow-up period was thirty-nine months. The subjects were divided into two groups; Group I consisted of thirty-seven feet in twenty-two patients who underwent a calcaneal lengthening osteotomy, and Group II comprised forty-four feet in twenty-five patients who underwent an extra-articular subtalar arthrodesis. Preoperative and final follow-up radiographs and dynamic pedobarographs were used to evaluate the results.

Results: The feet in both groups were found to be similarly deformed before surgery, by radiographic measurements and dynamic foot-pressure analysis. Both operative procedures led to improved radiographic indices; however, calcaneal pitch failed to improve after the subtalar arthrodesis. After surgery, the relative vertical impulse was decreased for the hallux, first metatarsal head, and medial aspect of the midfoot in both groups, while it was increased for the lateral aspect of the midfoot and calcaneus. On the other hand, postoperatively, the relative vertical impulse of the medial aspect of the midfoot was higher and the relative vertical impulse of the first through fourth metatarsal heads was lower in the group that had subtalar arthrodesis compared with the group that had a calcaneal lengthening osteotomy and the normal control subjects.

Conclusions: Extra-articular subtalar arthrodesis appears to be an effective means to achieve predictable correction of severe valgus deformity of the heel in patients with cerebral palsy who are able to walk; however, supination deformity of the forefoot remains and calcaneal equinus is not corrected. On the other hand, we believe that the calcaneal lengthening osteotomy is the treatment of choice because postoperative foot-pressure distribution more closely approximates the normal foot-pressure distribution.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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