Equinus deformity of the ankle at pediatric ages
Keywords:
equinus ankle deformity, equinovarus, equinovalgus, Achilles tendon Z-plasty, Achilles tendon lengthening, hemiepiphysiodesisAbstract
Equinus deformity of the ankle occurs as a consequence of multiple entities. Although the first line of treatment is conservative, surgical modalities are necessary in most pediatric patients. The latter are the most used for areas of the muscle-tendinous complex, especially fractional and Z-plasty-shaped lengthening. The aim of this work is to update and provide information on the different surgical procedures in the correction of equinus deformity of the ankle. In the search and analysis of the information, the following words were used: equinus deformity, equinovarus, equinovalgus; drop foot deformity and Achilles tendon Z-lengthening. Based on the information obtained, a bibliographic review of a total of 187 articles published in PubMed, Hinari, SciELO, EBSCO, Scopus, Medscape and Medline databases was carried out using the search manager and reference administrator EndNote. Of these, 30 were used, 28 of the last five years. Reference is made to the essential anatomy of the area, as well as to the Silfverskiöld test. In relation to imaging, the technique to calculate the distance of the tendon to be lengthened is described. Fractional lengthening surgical techniques are mentioned, by Z-plasty, anterior transposition of the Achilles tendon and hemiepiphysiodesis.Downloads
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References
1. Ebert N, Ballhause TM, Babin K, et al. Correction of recurrent equinus deformity in surgically treated clubfeet by anterior distal tibial hemiepiphysiodesis. J Pediatr Orthop. 2020;40(9):520-5. DOI: 10.1097/BPO.0000000000001609.
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3. Karol LA. Disorders of the Brain. En: Herring JA. Tachdjian's Pediatric Orthopaedics. 6th ed. Philadelphia: Elsevier; 2022. p.1420-96.
4. Volpon JB, Natale LL. Critical evaluation of the surgical techniques to correct the equinus deformity. Rev Col Bras Cir [Internet]. 2019 [citado 30/04/2023];46(1):e2054. Disponible en: https://www.scielo.br/j/rcbc/a/qnFMKmFs3czbJkyGNHkWQ6z/?lang=en
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6. Horsch A, Petzinger L, Ghandour M, et al. Defining equinus foot in cerebral palsy. Children (Basel). 2022;9(7):956. DOI: 10.3390/children9070956.
7. Kaneuchi Y, Otoshi K, Hakozaki M, et al. Talipes equinus deformity caused by fibrous gastrocnemius muscle contracture after direct contusion in football players: report of two cases. J Foot Ankle Surg. 2020;59(4):816-20. DOI: 10.1053/j.jfas.2019.10.004.
8. Gaber K, Mir B, Shehab M, et al. Updates in the surgical management of recurrent clubfoot deformity: a scoping review. Curr Rev Musculoskelet Med. 2022;15(2):75-81. DOI: 10.1007/s12178-022-09739-6.
9. Kaiser P, Guss D. Surgical management of musculotendinous balance in the progressive collapsing foot deformity: the role of peroneal and gastrocnemius contracture. Foot Ankle Clin. 2021;26(3):559-75. DOI: 10.1016/j.fcl.2021.06.005.
10. Feraru LM, Solomon ME. Gradual correction of pediatric equinus deformity. Clin Podiatr Med Surg. 2022;39(1):143-56. DOI: 10.1016/j.cpm.2021.09.006.
11. Sees JP, Miller F. The foot in cerebral palsy. Foot Ankle Clin. 2021;26(4):639-53. DOI: 10.1016/j.fcl.2021.07.002.
12. Spence DD, Sheffer BW. Cerebral palsy. En: Azae FM, Beaty JH. Campbell's operative Orthopaedics. 14th ed. Philadelphia: Elsevier; 2021. p. 1345-9.
13. Gendy S, ElGebeily M, El-Sobky TA, et al. Current practice and preferences to management of equinus in children with ambulatory cerebral palsy: A survey of orthopedic surgeons. SICOT J. 2019;5(3). DOI: 10.1051/sicotj/2019003.
14. Ozyalvac ON, Akpinar E, Gur V, et al. A Formula to Predict the Magnitude of Achilles Tendon Lengthening Required to Correct Equinus Deformity. Med Princ Pract. 2020;29(1):75-9. DOI: 10.1159/000501603.
15. Atef A, El-Rosasy M, El-Tantawy A. Talectomy for the management of resistant talipes equinovarus deformity; does adding Ilizarov external fixator provide extra advantages? J Foot Ankle Surg. 2020;60(2):307-11. DOI: 10.1053/j.jfas.2020.08.033.
16. Matsushita T, Watanabe Y, Takenaka N, et al. Correction of equinus deformity by means of a new unconstrained ilizarov frame system. Injury. 2021;52(7):2006-9. DOI: 10.1016/j.injury.2021.02.002.
17. Tan Q, Yang G, Liu Y, et al. Retrospective case analysis of 104 cases of talipes equinus. J Enviormental Public Health. 2022;2022:1-6. DOI: 10.1155/2022/9769092.
18. Arafa OM, Alzuhair AR, Alharbi SK, et al. Surgical correction of foot equino-cavocarus deformity in Klippel-Trénaunay-Weber syndrome: a case report. J Surg Case Rep. 2021;2021(10). DOI: 10.1093/jscr/rjab434.
19. Boffeli TJ, Gorman CM. Achilles lengthening and multiple Z-plasty in parallel for correction of toe walking associated with burn scar equinus contracture. J Foot Ankle Surg. 2019;58(5):1025-9. DOI: 10.1053/j.jfas.2019.01.007.
20. Du D, Zhang C. Two-incision, wire-assisted Achilles tendon Z-lengthening: surgical technique and case report. J Foot Ankle Surg. 2019;58(3):604-8. DOI: 10.1053/j.jfas.2018.11.003.
21. Rutz E, McCarthy J, Shore BJ, et al. Indications for gastrocsoleus lengthening in ambulatory children with cerebral palsy: a Delphi consensus study. J Child Orthop. 2020;14(5):405-14. DOI: 10.1302/1863-2548.14.200145.
22. Wegner M, Koyro KI, Kosegarten L, et al. Continuous wear of night and day orthosis is a key factor for improvement of fixed equinus deformity after the transverse Vulpius procedure. Children (Basel). 2022;9(2):209. DOI: 10.3390/children9020209.
23. Sclavos N, Thomason P, Passmore E, et al. Foot drop after gastrocsoleus lengthening for equinus deformity in children with cerebral palsy. Gait Posture. 2023;100:254-60. DOI: 10.1016/j.gaitpost.2023.01.007.
24. Dabash S, Potter E, Catlett G, et al. Taylor spatial frame in treatment of equinus deformity. Strategies Trauma Limb Reconstr. 2020;15(1):28-33. DOI: 10.5005/jp-journals-10080-1452.
25. Kirienko A, Gradov L, Malagoli E, et al. Correction of a complex foot deformity with V and Y osteotomy and Ilizarov method. J Foot Ankle Surg. 2022;61(6):1209-20. DOI: 10.1053/j.jfas.2022.02.005.
26. McKeithan LJ, Whitaker AT. Foot drop, hindfoot varus and tibialis posterior tendón transfer in cerebral palsy. Orthop Clin North Am. 2022;53:311-7. DOI: 10.1016/j.ocl.2022.03.005.
27. Varghese RA, Rebello G, Shah H, et al. Biomechanical basis for treatment of pediatric foot deformities part II: pathomechanics of common foot deformities. J Pediatr Orthop Soc N Am. 2022;4(2):1-18. DOI: 10.55275/JPOSNA-2022-0038.
28. Zargarbashi R, Abdi R, Bozorgmanesh M, et al. Anterior distal hemiepiphysiodesis of tibia for treatment of recurrent equinus deformity due to flat-top talus in surgically treated clubfoot. J Foot Ankle Surg. 2020;59(2):418-22. DOI: 10.1053/j.jfas.2019.08.018.
29. Giertych B, Galli S, Halanski M, et al. Anterior hemi-epiphysiodesis of the distal tibia for residual equinus deformity in children with clubfeet. J Pediatr Orthop Soc N Am. 2022;4(1):1-11. DOI: 10.55275/JPOSNA-2022-0004.
30. Tabaie SA, Videckis AJ. Achilles lengthening. J Pediatr Orthop Soc N Am. 2021;3(3). DOI: 10.55275/JPOSNA-2021-310.
2. Ferguson AB. Orthopaedic Surgery in Infancy and Childhood. 5th ed. London: Williams & Wilkins; 1981. p. 688-93.
3. Karol LA. Disorders of the Brain. En: Herring JA. Tachdjian's Pediatric Orthopaedics. 6th ed. Philadelphia: Elsevier; 2022. p.1420-96.
4. Volpon JB, Natale LL. Critical evaluation of the surgical techniques to correct the equinus deformity. Rev Col Bras Cir [Internet]. 2019 [citado 30/04/2023];46(1):e2054. Disponible en: https://www.scielo.br/j/rcbc/a/qnFMKmFs3czbJkyGNHkWQ6z/?lang=en
5. Canale ST, Beaty JH. Operative Pediatric Orthopaedics. St. Louis: Mosby Year Book; 1991. p. 663-6.
6. Horsch A, Petzinger L, Ghandour M, et al. Defining equinus foot in cerebral palsy. Children (Basel). 2022;9(7):956. DOI: 10.3390/children9070956.
7. Kaneuchi Y, Otoshi K, Hakozaki M, et al. Talipes equinus deformity caused by fibrous gastrocnemius muscle contracture after direct contusion in football players: report of two cases. J Foot Ankle Surg. 2020;59(4):816-20. DOI: 10.1053/j.jfas.2019.10.004.
8. Gaber K, Mir B, Shehab M, et al. Updates in the surgical management of recurrent clubfoot deformity: a scoping review. Curr Rev Musculoskelet Med. 2022;15(2):75-81. DOI: 10.1007/s12178-022-09739-6.
9. Kaiser P, Guss D. Surgical management of musculotendinous balance in the progressive collapsing foot deformity: the role of peroneal and gastrocnemius contracture. Foot Ankle Clin. 2021;26(3):559-75. DOI: 10.1016/j.fcl.2021.06.005.
10. Feraru LM, Solomon ME. Gradual correction of pediatric equinus deformity. Clin Podiatr Med Surg. 2022;39(1):143-56. DOI: 10.1016/j.cpm.2021.09.006.
11. Sees JP, Miller F. The foot in cerebral palsy. Foot Ankle Clin. 2021;26(4):639-53. DOI: 10.1016/j.fcl.2021.07.002.
12. Spence DD, Sheffer BW. Cerebral palsy. En: Azae FM, Beaty JH. Campbell's operative Orthopaedics. 14th ed. Philadelphia: Elsevier; 2021. p. 1345-9.
13. Gendy S, ElGebeily M, El-Sobky TA, et al. Current practice and preferences to management of equinus in children with ambulatory cerebral palsy: A survey of orthopedic surgeons. SICOT J. 2019;5(3). DOI: 10.1051/sicotj/2019003.
14. Ozyalvac ON, Akpinar E, Gur V, et al. A Formula to Predict the Magnitude of Achilles Tendon Lengthening Required to Correct Equinus Deformity. Med Princ Pract. 2020;29(1):75-9. DOI: 10.1159/000501603.
15. Atef A, El-Rosasy M, El-Tantawy A. Talectomy for the management of resistant talipes equinovarus deformity; does adding Ilizarov external fixator provide extra advantages? J Foot Ankle Surg. 2020;60(2):307-11. DOI: 10.1053/j.jfas.2020.08.033.
16. Matsushita T, Watanabe Y, Takenaka N, et al. Correction of equinus deformity by means of a new unconstrained ilizarov frame system. Injury. 2021;52(7):2006-9. DOI: 10.1016/j.injury.2021.02.002.
17. Tan Q, Yang G, Liu Y, et al. Retrospective case analysis of 104 cases of talipes equinus. J Enviormental Public Health. 2022;2022:1-6. DOI: 10.1155/2022/9769092.
18. Arafa OM, Alzuhair AR, Alharbi SK, et al. Surgical correction of foot equino-cavocarus deformity in Klippel-Trénaunay-Weber syndrome: a case report. J Surg Case Rep. 2021;2021(10). DOI: 10.1093/jscr/rjab434.
19. Boffeli TJ, Gorman CM. Achilles lengthening and multiple Z-plasty in parallel for correction of toe walking associated with burn scar equinus contracture. J Foot Ankle Surg. 2019;58(5):1025-9. DOI: 10.1053/j.jfas.2019.01.007.
20. Du D, Zhang C. Two-incision, wire-assisted Achilles tendon Z-lengthening: surgical technique and case report. J Foot Ankle Surg. 2019;58(3):604-8. DOI: 10.1053/j.jfas.2018.11.003.
21. Rutz E, McCarthy J, Shore BJ, et al. Indications for gastrocsoleus lengthening in ambulatory children with cerebral palsy: a Delphi consensus study. J Child Orthop. 2020;14(5):405-14. DOI: 10.1302/1863-2548.14.200145.
22. Wegner M, Koyro KI, Kosegarten L, et al. Continuous wear of night and day orthosis is a key factor for improvement of fixed equinus deformity after the transverse Vulpius procedure. Children (Basel). 2022;9(2):209. DOI: 10.3390/children9020209.
23. Sclavos N, Thomason P, Passmore E, et al. Foot drop after gastrocsoleus lengthening for equinus deformity in children with cerebral palsy. Gait Posture. 2023;100:254-60. DOI: 10.1016/j.gaitpost.2023.01.007.
24. Dabash S, Potter E, Catlett G, et al. Taylor spatial frame in treatment of equinus deformity. Strategies Trauma Limb Reconstr. 2020;15(1):28-33. DOI: 10.5005/jp-journals-10080-1452.
25. Kirienko A, Gradov L, Malagoli E, et al. Correction of a complex foot deformity with V and Y osteotomy and Ilizarov method. J Foot Ankle Surg. 2022;61(6):1209-20. DOI: 10.1053/j.jfas.2022.02.005.
26. McKeithan LJ, Whitaker AT. Foot drop, hindfoot varus and tibialis posterior tendón transfer in cerebral palsy. Orthop Clin North Am. 2022;53:311-7. DOI: 10.1016/j.ocl.2022.03.005.
27. Varghese RA, Rebello G, Shah H, et al. Biomechanical basis for treatment of pediatric foot deformities part II: pathomechanics of common foot deformities. J Pediatr Orthop Soc N Am. 2022;4(2):1-18. DOI: 10.55275/JPOSNA-2022-0038.
28. Zargarbashi R, Abdi R, Bozorgmanesh M, et al. Anterior distal hemiepiphysiodesis of tibia for treatment of recurrent equinus deformity due to flat-top talus in surgically treated clubfoot. J Foot Ankle Surg. 2020;59(2):418-22. DOI: 10.1053/j.jfas.2019.08.018.
29. Giertych B, Galli S, Halanski M, et al. Anterior hemi-epiphysiodesis of the distal tibia for residual equinus deformity in children with clubfeet. J Pediatr Orthop Soc N Am. 2022;4(1):1-11. DOI: 10.55275/JPOSNA-2022-0004.
30. Tabaie SA, Videckis AJ. Achilles lengthening. J Pediatr Orthop Soc N Am. 2021;3(3). DOI: 10.55275/JPOSNA-2021-310.
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Published
2024-02-14
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Álvarez-López A, Bello-Jiménez CC. Equinus deformity of the ankle at pediatric ages. Rev Méd Electrón [Internet]. 2024 Feb. 14 [cited 2025 Feb. 2];46:e5271. Available from: https://revmedicaelectronica.sld.cu/index.php/rme/article/view/5271
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