Surgical treatment of equinus deformity in cerebral palsy by aponeurosis lengthening and Z-lengthening

Surgical treatment of equinus deformity in cerebral palsy can be carried out successfully by Achilles tendon lengthening and gastrocnemius aponeurosis lengthening. From 1993 to 1998, we performed 59 operations in 37 cerebral palsied patients with equinus deformity using Z-lengthening in 30 cases and a modified Baker's procedure in 29 cases. The operations, associated with other hip and knee procedures in 65% of patients, were followed by postoperative use of casts and by a 12-month intensive kinesitherapeutic protocol. On preoperative evaluation, besides pattern deformity and the condition of proximal joints, we considered also age, clinical diagnosis, nature of tone and muscle strength. In most cases, the retrospective analysis showed the correction of deformity and a functional improvement. We observed 9 recurrences in six of the younger patients without relationship with topographic pattern of cerebral palsy. Overcorrection of equinus deformity occurred in one diplegic child who had phasic hypertonia and low muscle strength. We believe that the evaluation of patients, the preoperative planning and the effective kinesitherapeutic program are necessary to reduce the risk of complications related to surgery.