Module 43, Pediatric Orthopaedist Level

A six year old female followed for spastic quadriplegic cerebral palsy presented with increasing difficulty with ambulation secondary to bilateral hamstring tightness and progressive planovalgus deformity of the feet. Examination revealed a small thin six year-old female with severe bilateral planovalgus deformity. progressive problem. While walking, the bilateral planovalgus deformity causes her to bear weight on her medial midfoot.

Question 43A

Following correction of the planovalgus feet, lengthening of the gastrocnemius is going to be required.

Question 43B

A good long term correction of these feet can be expected with only a lateral column calcaneal lengthening.

Question 43C

The goal of this girl's surgery should be ambulating with plantigrade feet in neutral varus/valgus angulation, normal knee extension in stance phase, and no need for orthotics.

Question 43D

Arthrodesis of subtalar joint with vitallium staples is another option for treating this deformity.

Question 43E

A major problem in any correction of the subtalar joint is midfoot deformity in the ambulating child with ongoing spasticity. .