NEUROGENIC FOOT DEFORMITIES – OPTIMAL TREATMENT FOR INDIVIDUAL FOOT DEFORMITIES

Abstract

Introduction: Patients with cerebral palsy or other neurological diseases have a high incidence of foot deformities, limiting the mobility and quality of life for these patients. We analyzed the results of surgical correction and determined the optimal treatment for the main deformities.

Material and Methods: We analysed retrospectively the results of surgical correction of foot deformities. 87 Patients were treated between 1995 and 2003. We have actual data from 51 Patients (59%) with 68 feet treated. Mean follow up time is 4,25 years. We had 23 Patients with neurogenic clubfoot, 16 with flatfoot, 25 with pes equinus, 2 pes cavus and 2 hallux valgus. Of these patients 73% were able to walk before surgery.

Results: For the quality of life we evaluated pain, problems while walking and problems with ulcers with a Visual Analogue Scale (0–10). Pain decreased from 4,01 to 1,58 (p< 0.001), Problems with walking improved from 6,87 to 3,31 (p< 0.001), Problems with ulcers improved from 3,79 to 1,35 (p< 0.001). Maximum walking time increased from a mean of 17 minutes to 52 minutes (p< 0.001). The level of mobility was increased in 34%.

These results were the basis for the analysis of the best treatment for each deformity. For each group (neurogenic clubfoot, flatfoot and equinus) the best and poorest patients were selected and analysed. What was the diagnosis, indication for surgery, mobility and expectations of the patient before the surgery compared with the outcome.

Discussion: Surgical reconstruction of neurogenic foot deformities shows very good results. Essential is a muscular balancing to achieve long lasting results. Regular physiotherapy and night orthoses can improve the outcome.