Of 23 children (35 feet) with cerebral palsy who had undergone a Grice extra-articular subtalar arthrodesis for a valgus hindfoot between 1976 and 1981, we reviewed 17 (26 feet), at a mean of 20 years (17 years 3 months to 22 years 4 months) after operation. Seven were quadriplegic, eight spastic diplegic, and two hemiplegic. They were all able to walk at the time of operation.

Thirteen patients (20 feet) were pleased with the Grice procedure, 13 had no pain and 15 (23 feet) were still able to walk. The clinical results were satisfactory for most feet. Radiography showed that the results had been maintained over time but 14 feet developed a mean ankle valgus of 11° (6 to 18) with a compensatory hindfoot varus in 12 feet. No deformity of the talus or arthritis of adjacent joints was noted.

The Grice procedure gives good long-term results in children with cerebral palsy.

Purpose: Assessment of orthopaedic or surgical treatment in children with cerebral palsy is essential. For the lower limb, the main objective is to improve walking. Gait and control of static and dynamic posture are closely related. In this preliminary study, we attempted to determine whether treatment of pes equin which perturbs gait and equilibrium improves control of static and dynamic posture.

Material: Four children with spastic diplegia, one boy and three girls, aged five to fourteen years participated in this preliminary study. These children had unilateral or bilateral fixed or dynamic pes equin requiring medical (injection of botulinic toxin and/or lengthening casts) or surgical (aponeurotomy of the gastrocnemius) management.

Methods: Balance Master® was used for the posturographic evaluation. This system uses a force platform for calculating the vertical component at the centre of downward force on the feet. Five tests were used: distribution of body weight, stability in different sensorial conditions, single stance stability, limits of stability, rhythmic balancing movements. These tests were performed during the month preceding treatment and two and four months after treatment.

Results: For distribution of body weight, two children clearly improved after treatment. For the stability test in different sensorial conditions, all children showed improvement. There was no real improvement in the single stance test but two children who had had a unilateral treatment exhibited degradation on the untreated side. The rhythmic balancing movements test revealed an improvement in directional control in three of the four children.

Discussion and conclusion: This preliminary study demonstrated the feasibility of obtaining an easily implemented patient-friendly assessment of static and dynamic posture control in very young children with cerebral palsy. The Balance Master® system appears to be an interesting research tool for assessing posture control before and after treatment and might also be a useful rehabilitation tool.

Our aim in this retrospective study was to analyse the value of serial corrective casts in the management of toe-walking in children aged less than six years with cerebral palsy. A total of 20 children (10 hemiplegic and 10 diplegic) had elongation of the triceps surae by serial casting at a mean age of four years and one month. The mean passive dorsiflexion of the foot with the knee in extension was 3° (−10 to +5) and 12° (0 to +15) with the knee in flexion. After removal of the cast passive dorsiflexion was 20° (+10 to +30) with the knee in extension, and 28° (+10 to +35) with the knee in flexion. At a mean follow-up of 3.08 years (2.08 to 4.92), passive dorsiflexion was 9° (−10 to +20) with the knee in extension and 18° (0 to +30) with the knee in flexion.

Serial corrective casts are useful for the treatment of equinus in young children as the procedure is simple and the results are at least equal to those of other non-operative techniques. It is a safe alternative to surgical procedures especially in young children. If the equinus recurs operation can be undertaken on a tendon which is not scarred.