Equinovarus Foot Deformity in Cerebral Palsy

Abstract

Foot deformities are very common in children with Cerebral Palsy (CP). The most common foot deformity is pure equinus. Many children as they grow the equinus either fall into varus or valgus. For those children with bilateral involvement, collapse of the foot into planovalgus is most common. Children who are unilaterally involved have more tendencies to collapse towards varus. Almost all of these deformities continue to include equinus as a component. It is important to note though that both unilaterally and bilaterally involved individuals may go either direction. Treatment in early childhood of the equinus and equinovarus feet is primarily by the use of orthotics. Those children who cannot tolerate orthotics may have a trial of botulinum toxin injection, and if not successful, only the equinus should be treated by tendon lengthening. After age 8 years, it is appropriate to investigate the possibility of doing tendon transfers of the tibialis posterior or the tibialis anterior using gait analysis and muscle electromyography. Earlier tendon transfers before age 8 years run a high risk of overcorrecting the foot into planovalgus. However, if there is too much delay and hindfoot stiffness occurs, then there is a high risk of recurrent varus deformity from tendon transfers. These recurrent deformities often require osteotomies or fusion for correction. The evolution of the foot deformities in young children with CP is very unpredictable; therefore, it is imperative that close clinical follow-ups occur and most of the surgical treatments for the equinovarus foot deformity should be occurring after age 8 years.