Surgical treatment of equinus deformity in patients with cerebral palsy of preschool and early school age

BACKGROUND: Cerebral palsy is a severe disorder of the nervous and musculoskeletal systems. Equinus foot deformity is the most commonly diagnosed deformity. Surgical treatment is required in 12%–70% of patients. Existing surgical treatments are complicated by loss of improvement, relapse, and recurrent deformity in 6.7%–41.0% of cases.
AIM: The aim of the study was to determine the optimal surgical treatment algorithm for preschool and early school-aged patients with cerebral palsy.
MATERIALS AND METHODS: A clinical study included 102 children with cerebral palsy aged 3–10 years. Two groups of children were formed: group 1 for 3–6-year-old patients, group 2 for 7–10-year-old patients. The follow-up period was from 2014 to 2023. Equinus foot deformity was the main symptom in children. The GMFCS, Ashwort, and Boyd–Graham scales were used to assess patients. The severity of the foot deformity was evaluated by the author’s method (Invention Patent of the Russian Federation No. 2712951). Grade I deformity was reported in patients who required a force of 5–7 kg/cm2 to move the foot to a 90° angle, grade II deformity was reported with a force of 8–10 kg/cm2, and grade III deformity was reported with a force of more than 10 kg/cm2. All children underwent surgery: selective myotomy of the gastrocnemius muscle of the lower leg in 65 (63.7%) patients (Intervention Patent of the Russian Federation No. 2332180) and partial achillotomy in 37 (36.3%) patients (Intervention Patent of the Russian Federation No. 2819283).
RESULTS: Spastic diplegia was diagnosed in 59 (57.8%) patients and hemiplegia was diagnosed in 43 (42.2%) patients. Grade I, II, and III equinus foot deformities were diagnosed in 29, 36, and 37 patients, respectively. Selective myotomy was performed in 37 children in group 1 and in 28 children in group 2. Partial achillotomy was performed in 18 and 19 patients in both groups, respectively. Selective myotomy was performed in 63.7% of children in both groups with grades I and II equinus foot deformity, and partial achillotomy was performed in 36.3% of children with cerebral palsy with grade III equinus foot deformity. Treatment results are considered satisfactory in 95.1% of cases.
CONCLUSIONS: The surgical treatment algorithm is effective in children 3–10 years of age with intact intelligence and 
independent mobility. For patients with cerebral palsy with grade I and II equinus foot deformities, selective myotomy of the gastrocnemius muscle is recommended, whereas for patients with grade III deformity, partial achillotomy is recommended.