![]() ![]() The exclusion criteria were (1)incorrect diagnosis, (2)varus or neutral foot at initial presentation i.e., talo-2 ndMT angle< 10°, (3)inadequate radiographs, such as inadequate weight-bearing, (4)involved side of hemiplegia, and (5)GMFCS levels IV and V. We screened patients seen between May 2003 and May 2019 via clinical data warehouse to identify those with CP who were ≤ 18 years of age, who had been followed up for more than 1 year, with at least two standing AP and lateral foot radiographs.Īfter screening, two authors(JJM and MSP) reviewed and screened medical records and radiographs. Informed consent was waived due to retrospective nature of the study. This retrospective study was approved by the institutional review board of tertiary referral center for CP (IRB no. Therefore, the purpose of this study was to evaluate the trend in radiologic changes of CP patients with PV deformity according to age and identify influencing factors. However, there are few studies that invistigated progression of PV in CP patients. Also, recurrence of PV after calcaneal lengthening is greater in GMFCS III and IV patients, implying that PV can progress even after the surgical procedure. While spasticity continuously affects the extremities, forefoot dragging due to malrotated lever and Achilles contractures may further interrupt spontaneous improvement observed in idiopathic PV. However, PV deformity in CP may not follow this pattern, since underlying condition does not disappear. The anteroposterior(AP) talo-1stMT and lateral talo-1stMT angles improved annually until skeletal maturity. Idiopathic PV in children and adolescents improves as patients grow older, as seen in cross-sectional studies, and its spontaneous recovery has also been proven radiographically in a longitudinal study. In patients who already have weak muscles, lever-arm dysfunctions further worsen their ambulatory function. Furthermore, in patients with CP, PV results in lever-arm dysfunction : not only is PV a prototype of a flexible lever arm, but it also causes malrotated lever-arm dysfunction by shortening foot lever due to the externally rotated or abducted forefoot. Due to prominent talar head, PV frequently leads to pain during weight-bearing. PV in CP most likely results from muscle imbalance and spasticity in a skeletally developing foot. Pes planovalgus(PV) is one of the most common foot deformities in patients with cerebral palsy(CP), especially in patients with diplegia and quadriplegia. Physicians should take this result into consideration when planning the timing of the surgery. ![]() The AP talo-1 stMT and talo-2ndMT angles progressed in patients with GMFCS levels II and III. The GMFCS level was the single most important factor influencing the progression of radiographic indices in PV deformity in CP. In GMFCS level III patients, there was no significant improvement in the lateral talo-1 stMT angle ( p = 0.0535). The lateral talo-1stMT angle showed improvements in GMFCS level I and II patients (0.43°, p < 0.0001, and 0.61°, p < 0.0001, respectively). HV was significantly affected by age in all three GMFCS groups it increased by 0.48° ( p < 0.0001), 0.66° (p < 0.0001), and 1.19° (p < 0.0001) for levels I, II, and III, respectively. The AP talo-2 ndMT angle progressed by 0.59° ( p < 0.0001) and 0.64° ( p = 0.0007) in GMFCS level II and III patients, respectively however, there was no significant change in GMFCS level I patients ( p = 0.3269). Overall, 194 patients were enrolled in this study, and 1272 standing foot radiographs were evaluated. The rate of progression was adjusted by multiple factors using the linear mixed model, with the Gross Motor Function Classification System(GMFCS) level as the fixed effect and age and each subject as random effects. Anteroposterior and lateral talo-first metatarsal(talo-1stMT), talo-second metatarsal(talo-2ndMT), and hallux valgus(HV) angles were measured on the radiographs. MethodsĬP patients with PV deformity younger than 18 years old who had undergone more than a year of follow-up with at least two standing foot radiographs were included. ![]() Analyzing radiographic changes of pes planovalgus(PV) deformity of cerebral palsy(CP) patients according to age and influencing factors. ![]()
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