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Foot and Ankle in CP

- Discussion:
    - pattern of cerebral palsy influences type of foot & ankle deformities;
    - ankle equinus:
    - equinovarus:
    - pes valgus:
    - equinovalgus deformity:
         - is more common in children w/ diplegia and spastic quadriplegia;
         - in ambulatory children, mild deformity can be corrected w/ peroneal tendon lengthening (transfer of brevis to posterior tibialis is 
                unreliable) combined w/ achilles tendon lengthening;
         - if heel valgus is pronouned, medial displacement os calcis osteotomy can be added;
         - if heel valgus and forefoot pronation are marked, opening wedge osteotomy of the anterior calcaneal process can be performed;
         - if hindfoot is in rigid valgus, it is best to combine an extra-articlar subtalar fusion with the tendon lengthening;
         - more common in spastic diplegia;
         - caused by spastic peroneals, contracted heel cords;
         - peroneus brevis lengthening is helpful to correct moderate valgus;
         - subtalar arthrodesis is reserved for severe valgus deformities;
    - diff dx: toe walking

Chronologic outcome of surgical tendoachilles lengthening and natural history of gastroc-soleus contracture in cerebral palsy. A two-part study.

A Prospective Study of Inhibitive Casting as an Adjunct to Physiotherapy for Cerebral-Palsied Children

Equilibrium reactions in the feet of children with spastic cerebral palsy and of normal children.  

Surgical correction of equinus deformity in cerebral palsy.     

Long-Term Results After Gastrocnemius-Soleus Intramuscular Aponeurotic Recession as a Part of Multilevel Surgery in Spastic Diplegic Cerebral Palsy