Local and distant effects of isolated calf muscle lengthening in children with cerebral palsy and equinus gait. Lofterød B, Terjesen T. Journal of Children's Orthopaedics 2008;1:55–62

H Kerr Graham,Paulo Selber

doi:10.1007/s11832-008-0116-y

H Kerr Graham, Paulo Selber

Open Access

https://doi.org/10.1007/s11832-008-0116-y

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Abstract

EPOS 2008 Dear Sir We have two principal concerns about the article by Lofterod and Terjesen, ‘‘Local and distant effects of isolated calf muscle lengthening in children with cerebral palsy and equinus gait’’. First, after 15 years of continuous work in the Hugh Williamson Gait Laboratory, in which we have assessed several thousand children with cerebral palsy, we think we have only now found our first subject with diplegic cerebral palsy who might be a good candidate for isolated calf-lengthening surgery. We suggest that the indication for isolated calf lengthening in spastic diplegia is very small indeed and if over used is liable to result in calcaneus gait. The majority of our patients who appear to have a true equinus gait pattern have occult spasticity and/ or contractures proximally that need to be dealt with at the

Highlights

The authors were kind enough to quote our extensive study of calf-lengthening surgery published in 2001, there is a crucial difference between the study by Lofterød and Terjesen and that by us—with respect to the length of follow-up
Lofterød and Terjesen are in a position to provide very important information if they can follow-up and report their surgical outcomes at 5–10 years after the index surgery
It is of interest that Rethlefsen and Kay have expressed similar concerns regarding another study reporting the outcome of Achilles tendon lengthening in spastic diplegia [3, 4]