Subtalar stabilization of the planovalgus foot by staple arthroereisis in young children who have neuromuscular problems.

Abstract

A new approach was developed for the treatment of planovalgus feet in children who have spastic cerebral palsy and are less than six years old. The procedure consists of subtalar stabilization (arthroereisis) with a Vitallium staple, and it corrects alignment, restores balance, and allows continued function. It is safe, technically simple, and efficient. Between 1980 and 1988, forty-eight arthroereises were done. The results of thirty-one procedures in twenty patients who were two to ten years and ten months old at the time of the operation were followed for an average of 4.1 years (range, two to seven years). Approximately 85 per cent of the results were excellent or good. Only one foot needed a revision; this was due to migration of the staple. At the most recent follow-up, the talocalcaneal angle had not changed in about 50 per cent of the feet. In another seven, the change ranged from 5 to 10 degrees. All of these patients had a satisfactory result. In all but three feet, the goal of maintaining the stability of the talocalcaneal joint without orthotics or osseous fusion was achieved. Originally, the procedure was done only in patients who were less than six years old, but, because of its success, the indications were extended to children of any age who had severely involved and neurologically compromised feet. Satisfactory results were obtained in the older children as well.