title: Mid-term Results of Intramuscular Lengthening of Gastrocnemius and/or Soleus to Correct Equinus Deformity in Flatfoot.
abstract: BACKGROUND
  Intramuscular lengthening of the gastrocnemius and/or soleus (Baumann procedure) is widely used in patients who have cerebral palsy, with several advantages over other lengthening techniques. Tightness of the gastrocnemius or gastrocnemius-soleus complex has been confirmed to be related to flatfoot deformity. The purpose of this study was to evaluate the mid-term results of the Baumann procedure as a part of the treatment of flatfoot with equinus deformity.
  
  
  METHODS
  We reviewed 35 pediatric and adult patients (43 feet) with flatfoot who underwent the Baumann procedure for the concomitant equinus deformity. The mean duration of follow-up was 39.4 months. Preoperative and follow-up evaluations included the maximal angle of dorsiflexion of the ankle with the knee fully extended and with the knee flexed to 90 degrees, the American Orthopaedic Foot & Ankle Society ankle-hindfoot (AOFAS-AH) scores, and postoperative complications.
  
  
  RESULTS
  Preoperatively, the mean angle of passive ankle dorsiflexion with the knee extended was -4.7 ± 2.7 degrees and that with the knee flexed was 2.3 ± 2.5 degrees. At the final follow-up, both values improved significantly by a mean of 13.6 degrees (P < .001) and 9.7 degrees (P < .001), respectively. The average AOFAS-AH scores improved from 56.8 points preoperatively to 72.1 at the final follow-up. Recurrence of equinus was observed in 3 patients (4 feet). There were no cases of overcorrection, neurovascular injury, or healing problems.
  
  
  CONCLUSIONS
  Our results indicate that the Baumann procedure can effectively and sequentially correct the tightness of the gastrocnemius or the gastrocnemius-soleus complex in patients with flatfoot deformity, without obvious postoperative complications.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China Department of Orthopaedics, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Rong
authors.affiliation: Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China Department of Orthopaedics, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Wen-tao
authors.initials: WT
authors.lastname: Ge
authors.affiliation: Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China Department of Orthopaedics, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Xing-chen
authors.initials: XC
authors.lastname: Li
authors.affiliation: Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China Department of Orthopaedics, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China xu664531@hotmail.com.
authors.forename: Xiang-yang
authors.initials: XY
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D015331:Cohort Studies; D016001:Confidence Intervals; D004863:Equinus Deformity / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005413:Flatfoot / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D056888:Patient Positioning / Q000379:methods; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D058971:Tenotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Baumann procedure; equinus contracture; flatfoot; intramuscular lengthening