Abstract

BackgroundAnalyzing radiographic changes of pes planovalgus(PV) deformity of cerebral palsy(CP) patients according to age and influencing factors.MethodsCP patients with PV deformity younger than 18 years old who had undergone more than a year of follow-up with at least two standing foot radiographs were included. Anteroposterior and lateral talo-first metatarsal(talo-1stMT), talo-second metatarsal(talo-2ndMT), and hallux valgus(HV) angles were measured on the radiographs. The rate of progression was adjusted by multiple factors using the linear mixed model, with the Gross Motor Function Classification System(GMFCS) level as the fixed effect and age and each subject as random effects.ResultsOverall, 194 patients were enrolled in this study, and 1272 standing foot radiographs were evaluated. The AP talo-2ndMT angle progressed by 0.59° (p < 0.0001) and 0.64° (p = 0.0007) in GMFCS level II and III patients, respectively; however, there was no significant change in GMFCS level I patients (p = 0.3269). HV was significantly affected by age in all three GMFCS groups; it increased by 0.48° (p < 0.0001), 0.66° (p < 0.0001), and 1.19° (p < 0.0001) for levels I, II, and III, respectively. The lateral talo-1stMT angle showed improvements in GMFCS level I and II patients (0.43°, p < 0.0001, and 0.61°, p < 0.0001, respectively). In GMFCS level III patients, there was no significant improvement in the lateral talo-1stMT angle (p = 0.0535).ConclusionsThe GMFCS level was the single most important factor influencing the progression of radiographic indices in PV deformity in CP. The AP talo-1stMT and talo-2ndMT angles progressed in patients with GMFCS levels II and III. Physicians should take this result into consideration when planning the timing of the surgery.Level of evidencePrognostic Level IV.

Highlights

  • Analyzing radiographic changes of pes planovalgus(PV) deformity of cerebral palsy(CP) patients according to age and influencing factors

  • Hallux valgus (HV) was significantly affected by age in all three Gross Motor Function Classification System (GMFCS) groups, increasing by 0.48° (p < 0.0001), 0.66°

  • There was no significant improvement in the lateral talo-1stMT angle(p = 0.0535)in GMFCS III patients (Table 6)

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Summary

Introduction

Analyzing radiographic changes of pes planovalgus(PV) deformity of cerebral palsy(CP) patients according to age and influencing factors. Pes planovalgus(PV) is one of the most common foot deformities in patients with cerebral palsy(CP), especially in patients with diplegia and quadriplegia [1]. PV in CP most likely results from muscle imbalance and spasticity in a skeletally developing foot [2]. In patients with CP, PV results in lever-arm dysfunction [3]: is PV a prototype of a flexible. Idiopathic PV in children and adolescents improves as patients grow older [7,8,9], as seen in crosssectional studies [8, 9], and its spontaneous recovery has been proven radiographically in a longitudinal study [7]. While spasticity continuously affects the extremities, forefoot dragging due to malrotated lever and Achilles contractures may further

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