Abstract
Despite the large number of studies on the recurrence after surgery for equinus foot deformity in cerebral palsy (CP) patients, only a few investigations have reported long-term recurrence rates. Furthermore, little is known on the interval between the recurrent surgeries and the factors that lead to early recurrence. This study aimed to assess the overall recurrence after surgery for equinus foot deformity in patients with CP and to assess the factors associated with recurrence. We also aimed to determine the predisposing factors for early recurrence. The medical records of 186 patients (308 feet) were reviewed in order to determine the recurrence after surgery for equinus foot deformity. The type of CP, type of surgery, age at surgery, functional mobility, passive dorsiflexion of the ankle at the last follow-up visit, and subsequent treatment were recorded. Kaplan-Meier survival analysis was employed, with the end point defined as reoperation. The mean age at surgery was 6.8±2.5years (range, 2.2-13.1). With the mean follow-up period of 11.3years (range, 7.2-17.7), the overall recurrence rate was 43.8%. The recurrence rate was highest among patients with hemiplegia (62.5%). The Kaplan-Meier survival without repeat surgery estimate was shown to be 88.6% at 5years and 59.6% at 10years. Among children with hemiplegia and diplegia, the younger children (≤8years of age) showed a higher rate of recurrence compared with the older children (P=0.04 and P=0.01, respectively). In 41 feet (30.4%), reoperations were performed within 5years after the primary surgery. Early recurrence was most prevalent among children with hemiplegia (50.0%). In children with diplegia and quadriplegia, the younger children underwent the secondary operation later than the older children (P=0.04 and P=0.02, respectively). Recurrence after surgery for equinus foot deformity is common and the age at surgery has a significant influence on recurrence. Recurrence can occur at any age while the child is still growing; therefore, it is advised to follow those patients until they reach skeletal maturity. Level III, therapeutic study.
Highlights
Equinus foot deformity, caused by contracture of the triceps surae, is one of the most common deformities seen in patients with cerebral palsy (CP), with a direct impact on standing ability and gait [1,2,3,4,5]
Among children with hemiplegia and diplegia, the younger children (B8 years of age) showed a higher rate of recurrence compared with the older children (P = 0.04 and P = 0.01, respectively)
Recurrence can occur at any age while the child is still growing; it is advised to follow those patients until they reach skeletal maturity
Summary
Equinus foot deformity, caused by contracture of the triceps surae, is one of the most common deformities seen in patients with cerebral palsy (CP), with a direct impact on standing ability and gait [1,2,3,4,5]. The goal of treatment for the equinus deformity is to improve the gait in ambulatory patients and to achieve a plantigrade foot that enhances standing ability in non-ambulatory patients. Suggested risk or predisposing factors associated with the recurrence of equinus deformity include the age at the time of surgery, type of CP, type of surgery, and gender [16, 19,20,21,22,23]. Despite the large number of studies on the recurrence after surgery for equinus foot deformity in cerebral palsy (CP) patients, only a few investigations have reported long-term recurrence rates. This study aimed to assess the overall recurrence after surgery for equinus foot deformity in patients with CP and to assess the factors associated with recurrence. We aimed to determine the predisposing factors for early recurrence
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