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Double hindfoot arthrodesis technique for the treatment of severe equino-plano-valgus foot deformity in cerebral palsy

long-term results and radiological evaluation

Costici, Pier Francesco; Donati, Fabrizio; Russo, Rosa; Verardi, Caroline; Pagnotta, Gaetano

Journal of Pediatric Orthopaedics B: May 2019 - Volume 28 - Issue 3 - p 235–241
doi: 10.1097/BPB.0000000000000616

The aim of this study was to evaluate the clinical and radiological results of a double arthrodesis technique for the treatment of equino-plano-valgus foot deformity in pediatric patients affected by cerebral palsy. A retrospective evaluation was performed on 175 feet surgically treated with a talonavicular and calcaneocuboid joint fusion technique. The average age at surgery was 14.7 years (range: 12–20 years). Visual analogue scale for pain score, Gross Motor Function Classification System scale, talonavicular angle, Costa–Bertani angle, and Kite’s angle on standard weight bearing radiographs were evaluated preoperatively and postoperatively. The mean clinical follow-up was 62.4 months (range: 12–112 months). The mid Gross Motor Function Classification System scale value did not show a significant improvement in any of the subgroups considered. A significant improvement in the visual analogue scale for pain score value was evident 6 months after surgery. Radiological examination showed a statistically significant improvement in the talonavicular angle (average 7.4°) and the Costa–Bertani angle (average 128.5°). Complications occurred in 8.6% of cases. The described surgical technique is safe and efficacious, and could represent a useful option of treatment of equino-plano-valgus severe deformity in cerebral palsy patients older than 12 years of age.

Department of Orthopedics, Pediatric Hospital Bambino Gesu’, Rome, Italy

Correspondence to Fabrizio Donati, MD, Department of Orthopedics, Pediatric Hospital Bambino Gesu’, Rome 00168, Italy Tel: +39 380 319 7959; fax: +39 066 859 3249; e-mail:

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