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.

Aims: Instability and dislocation of the hip is one of the most striking problems for children and young people with neuromuscular disorders. The purpose of this study was to find out pathomechanical risk factors relating to specific neuromuscular disorders. We compared our findings with literature and questioned if there is any impact on current screening and treatment principles. Methods: In a prospective long-term-study 2500 patients with neuromuscular disorders regularly underwent analysis of both muscular dysfunction and structural deformities by clinical examination and native radiographs. Walking patients had additional slow motion video-analysis and in the case of surgical intervention pre- and postoperative 3D-gait analysis. The vast majority of patients with the TBI-type of cerebral palsy had unstable hips. 66 severely subluxated or dislocated hip joints underwent 3D-CT-scan examinations prior to surgical reconstruction, soft tissue releases and muscle transfers. Conclusions: Developmental biological studies presume that a complex systemic network of both genetical determining factors and external biomechanical influences affect physiological growth and maturing of the juvenile hip joint. Under clinical condiions it may be possible to discover and analyse some of the most important factors. Primary, compensating and secundary functional disorders have to be differentiated by clinical examination, radiographs, and motion analysis. Increased or spastic and decreased or paretic muscular activity may cause different degrees of muscular imbalance. Together with additional compensating movements they form specific pathological motor patterns which occur typically related to specific neuromuscular diseases.