title: Surgical technique: Medial column arthrodesis in rigid spastic planovalgus feet.
abstract: BACKGROUND
  Treatment of spastic planovalgus feet is challenging, especially in patients with severe and rigid deformities. The available techniques do provide some correction but not at the site of the deformity and sometimes the correction is lost over time. We describe a new surgical approach at the site of the deformity.
  
  
  METHODS
  Indications for the surgery included adolescents or young adults with severe and rigid planovalgus deformities of the feet resulting from cerebral palsy. Through a medial approach, arthrodesis of the talonavicular, navicular-medial cuneiform, and medial cuneiform first metatarsal joints was internally fixed using a single-molded plate over the plantar surface of the foot, recreating the longitudinal arch.
  
  
  METHODS
  We retrospectively reviewed 21 patients (35 feet) with spastic cerebral palsy in whom the new technique was indicated for severe and rigid deformity, gait dysfunction, and pain (mean age, 190 months; range, 96-345 months). The mean age of the patients was 16 years (range, 8-29 years). We analyzed the patients clinically and radiographically. The minimum followup was 2.5 years (mean, 58 months; range, 2.5-7.5 years).
  
  
  RESULTS
  At last followup, 34 of the 35 feet (97%) had radiographic improvement of the deformity with no difficulties wearing shoes; one patient had persistent pain despite bone union. Union was achieved initially in eight patients (17 feet) and in another eight (10 feet) after revision surgery, of 27 of the 35 feet. The radiographic calcaneal inclination angle improved an average of 13°. The lateral talocalcaneal angle decreased from a mean of 43° to 26° after surgery. Four patients (five feet) had revision surgery for pseudoarthrosis, and another four patients (five feet) had revision surgery for other problems.
  
  
  CONCLUSIONS
  Based on our preliminary observations, we believe stabilization of the medial column is a reasonable option for treating selected patients with severe and rigid planovalgus feet by providing a stable and pain-free foot, recreating the anatomy, and allowing the use of braces or regular shoes. Further studies with longer followup periods will be required to confirm these initial results and to verify if these findings persist over time.
  
  
  METHODS
  Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Departament of Orthopedics and Traumatology, Santa Casa de Misericórdia de São Paulo, R Dr Cesário Motta Jr, 112, São Paulo, SP 01221-020, Brazil. patricia@fucs.com.br
authors.forename: Patricia Maria
authors.initials: PM
authors.lastname: de Moraes Barros Fucs
authors.forename: Celso
authors.initials: C
authors.lastname: Svartman
authors.forename: Rodrigo Montezuma Cezar
authors.initials: RM
authors.lastname: de Assumpção
authors.forename: Helder Henzo
authors.initials: HH
authors.lastname: Yamada
authors.forename: Simone Dota
authors.initials: SD
authors.lastname: Simis
mesh_terms: D000293:Adolescent; D000328:Adult; D001174:Arthrodesis / Q000379:methods*; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D005260:Female; D005413:Flatfoot / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005531:Foot Deformities, Acquired / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D010243:Paralysis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
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