Extra-Osseous Talotarsal Stabilization (EOTTS) in Patients with Cerebral Palsy (CP) Results in Excellent Patient Reported Outcomes and Radiographic Realignment of Subtalar Joint Instability
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Abstract
Background: The aim of this prospective nonrandomized case series study was to assess the intermediateterm outcomes of extraosseous talotarsal stabilization (EOTTS) combined with Achilles tendon lengthening for correction of flexible planovalgus foot deformity in children with cerebral palsy. Methods: A total of 20 skeletally immature feet of 9 boys and 5 girls aged 7 to 15 years old (average 10.8 years), with Level I and II CP (according to the Gross Motor Function Classification System) and, were treated via EOTTS and Gastrocnemius recession or Achilles tendon lengthening. Six of them had diparetic and eight hemiparetic. The average follow-up time was 27.3 months (12 to 42 months). Preoperative and postoperative American Orthopedic Foot and Ankle Society-Ankle and Hindfoot (AOFAS-AH) scores, dorsoplantar talar second metatarsal angles (T2M), and lateral talar declination angles (TD) of the affected foot were recorded. Results: Correction of the preoperative talar alignment deformity was normalized in all patients. The average TDA improved from 30.06° ± 2.74° preoperatively to 20.76° ± 2.3° postoperatively. The mean T2MA improved from 39.06° ± 2.05° preoperatively to 15.92° ± 3.12° postoperatively. The AOFAS-AH score also improved from 62.8 ± 1.74 preoperatively to 87.8 ± 2.13 at the final follow-up. Conclusion: EOTTS and associated soft tissue procedures reliably corrected the hindfoot deformity and have shown to be a good treatment option in the treatment of flexible planovalgus feet in children with Level I and II CP.
