Ортопедическая коррекция пронационных деформаций стоп у детей с церебральным параличом

Abstract

Objective. Development of methods for orthopedic correction and evaluation of their efficacy, depending on the options of pronation foot deformities in children with cerebral palsy. Material and methods. The data obtained during the orthopedic treatment of 36 patients aged from 1 year to 7 years with pronation foot deformities on the background of cerebral palsy. Survey method involves determining the height of the longitudinal arch, plantography, deviation angle of the heel bone in the sagittal and frontal planes, X-ray examination. Results and conclusions. Correction of pronation deformities included the ankle-foot cast application for the gradual elimination of the certain elements of deformation. During the treatment of the first pronated foot type, we managed to correct the equinus foot deformity, grade I, in children under the age of 2.5 years. In other cases, we could not manage to achieve the correct heel bone position, even after the repeated serial casting. Failure of repeated serial casting had a negative impact on the formation of longitudinal arch of the foot. In the case of orthopaedic treatment of the second pronated foot type, alongside with both a flexible foot and the intact tarsal bones, we managed to achieve the correct bones shape. Under the condition of the rigid foot and the deformed tarsal bones, the prolonged plaster and splint immobilization were needed. In the course of treatment of the third deformation type, a positive effect was achieved on condition that the physiological calf muscle retraction was restored and the pathological tone of the m. tibialis anterior and musculi extensoris digitorum was eliminated. The negative factor were the gross anatomical abnormalities in the tarsal bones. However, orthopaedic treatment of the third variant of strain, grade II-III, carried out as preoperative preparation that permitted to limit the scope of surgical intervention.