In the treatment of equinus deformity in cerebral palsy, dynamic deformities should be distinguished from fixed structural contractures.
Spasticity and clonus can be relieved by selective neurectomy, whereas a fixed contracture requires lengthening of the musculotendinous mechanism.
The role of the gastrocnemius and soleus portions of the triceps surae in equinus deformity should be determined, and the appropriate muscle selected as the target for surgical treatment.
Postural deformities at the hip and knee must be carefully considered, and appropriate corrective procedures applied to them. Toe stance may be a compensatory mechanism secondary to postural deformities in the hip or knee and not a true equinus deformity.
The amount of musculotendinous lengthening needed for correction determines the site and technique selected for the surgical treatment of contractural equinus deformity.
The timing of the surgical treatment of equinus deformity is important. It should be avoided until after the child has reached the age of four years and, preferably, until after he has reached the age of eight years. If it is performed earlier in contractural equinus deformity, recurrence of deformity must be feared as the result of skeletal growth.
Healthy controversy may well continue with reference to the surgical procedures preferred. Of most importance is the accumulation of adequate data concerning patients accurately classified as to their problems, treatment, and end results. When such information is available, more rewarding end results can be achieved.
Copyright 1960 by The Journal of Bone and Joint Surgery, Incorporated