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Prevalence and classification of equinus foot in bilateral spastic cerebral palsy

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Abstract

Background

Equinus is a common deformity in children with bilateral spastic cerebral palsy (BSCP). While dynamic equinus usually is treated by conservative therapy, fixed contractures need surgical correction. To choose the appropriate surgical method, it is important to discriminate between isolated gastrocnemius shortening and combined gastrosoleus complex contracture.

Methods

In a retrospective study 938 patients with BSCP were studied. Patients underwent gait analysis and clinical examination. 248 patients (496 limbs) met the inclusion criteria. Data from motion analysis and clinical examination were used to calculate the prevalence and to further classify fixed equinus foot.

Results

The prevalence of equinus was 83.3%. During clinical exam 246 (59.6%) limbs showed combined gastrosoleus complex contracture and 167 (40.4%) isolated gastrocnemius contracture. Max. DF at stance and mean DF at initial contact were significantly reduced in combined contracture, while max. ROM was increased (P < 0.05).

Conclusions

Corroborating the results of previous studies, in this study there was a high prevalence of fixed equinus in patients with BSCP. The prevalence of equinus correlated with increasing age. As half of the patients with fixed equinus show a different involvement of gastrocnemius and soleus muscle, we recommend to apply Silfverskiöld’s test to discriminate between those two types to choose the appropriate surgical therapy.

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Acknowledgements

Essential participation in the concept and design of the study as well as acquisition, analysis and interpretation of data were done by all authors. The manuscript was edited and approved by all mentioned authors.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Heidelberg University Hospital, Clinic for Orthopedics and Trauma Surgery, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany

    Axel Horsch, Marco Götze, Andreas Geisbüsch, Nicholas Beckmann, Stefanos Tsitlakidis, Gregor Berrsche & Matthias Klotz

Authors
  1. Axel Horsch
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  2. Marco Götze
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  3. Andreas Geisbüsch
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  4. Nicholas Beckmann
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  6. Gregor Berrsche
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  7. Matthias Klotz
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Contributions

AH and MK devised the idea for the research project. AH analyzed the data and wrote the manuscript with input from all authors. All authors provided critical feedback and helped shape the research, analysis, and manuscript. MK supervised the project. GB greatly contributed to the critical revision of the article. All authors read and approved the final version of the manuscript.

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Correspondence to Axel Horsch.

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Ethical approval

The study was approved by the responsible Ethics Committee of Heidelberg University Hospital.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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Horsch, A., Götze, M., Geisbüsch, A. et al. Prevalence and classification of equinus foot in bilateral spastic cerebral palsy. World J Pediatr 15, 276–280 (2019). https://doi.org/10.1007/s12519-019-00238-2

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  • DOI: https://doi.org/10.1007/s12519-019-00238-2

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