Ann. Pak. Inst. Med. Sci. 2013; 9(3):146-149
Objective: The purpose of this study was to evaluate the result of percutaneous tendo-achilles lengthening as treatment for equines deformity in children with cerebral palsy and poliomyelitis.
study design: Descriptive Retrospective study.
Materials and Methods: This descriptive retrospective study was carried out in the department of pediatric surgery, the children’s hospital, PIMS, Islamabad for three years from June 2008 to June 2011. Children who were under 12 years of age with cerebral palsy and poliomyelitis having tendo-achilles shortening were included. Patients with varus deformity were excluded from the study. Twenty three patients out of them 14 having cerebral palsy and 9 having poliomyelitis were included in the study. Percutaneous tendo achilles lengthening was performed in all these patients. These patients were followed up for the next 3 to 12 months. Outcome of surgery was assessed on a pre-defined scale.
Results: Out of twenty three cases fourteen were of cerebral palsy and remaining nine had poliomyelitis. Over male to female ratio of total 23 cases, 16(69.5%) were male and 7 (30.5%) were female. The mean age of the patients was 7.6 years (range 3 to 12 years). Patients were followed up for the next 3 to 12 months. Out of total patients, 4 developed superficial wound site infection, 2 presented with recurrence and 2 cases failed to appear in follow up. We had outstanding results in 13 (56.5%) cases, 7 (30.4%) cases showed good result, result of 1 (4.3%) case was satisfactory and in 2 (8.7%) cases results were poor
Conclusions: Our conclusions were that elongation of tendo Achilles is a single stage operative procedure of choice without any significant risk to the patients with cerebral palsy and poliomyelitis.
Key Words: Cerebral palsy, poliomyelitis, Percutaneous tendo-achilles lengthening.
Introduction
Foot deformities are among one of the common congenital anomalies which has been described since ancient times.1 Any kind of congenital anomaly is psychological trauma for parents and if such anomaly is accompanied with a central nervous system disorder it is a source of great parental anxiety.2 Cerebral palsy and poliomyelitis are two devastating conditions of mankind. Both effect neuromuscular system, and results in functional disability of the individual. Cerebral palsy is the most common cause of physical disability effecting children in developed countries, with an incidence of 2.0 to 2.5 per 100 live births.1 cerebral palsy is a useful term which describes a large group of children with motor impairment from many causes and expressed as a wide variety of clinical syndromes.2 The definitions of cerebral palsy have undergone a number of refinements by developmental pediatricians and neurologists. They stress two features; first, cerebral palsy is the result of a lesion of a lesion in the immature brain, which is non-progressive; it is a static encephalopathy.3 secondly, cerebral palsy results in a disorder of posture and movement which is permanent but not unchanging.4 poliomyelitis is almost eradicated in advanced countries. However, in the sub-continent, we do come across a number of cases. In poliomyelitis there will be weakness of the involved limb, and with the continued growth of the limb there will be a progressive deformities and eventually results in loss of function.
Shortening of tendo Achilles or equines deformity is the commonest deformity in cerebral palsy and adversely affects standing balance and gait.5-10 Failure of conservative treatment such as physiotherapy, casting, and injections of botulinum toxin A may be an indication for surgical intervention.11-12 Many surgical procedures have been described for the treatment of this deformity such as: lengthening of the origin of the gastrocnemius aponeurosis, combined lengthening of the gastrocnemius and soleus fascia, and lengthening and translocation of tendo Achillis. 13-18 Gait analysis is the most sensitive and objective method of assessment.19 we accepted that not all patients would be suitable for gait analysis because of their limited functional abilities. We therefore undertook a study to see the results of percutaneous tendo Achilles lengthening in patients having cerebral palsy and poliomyelitis.
Download in PDF Format
